Sex Workers, Empowerment and Poverty Alleviation in Ethiopia

EVIDENCE REPORT No 80

IDSSexuality, Poverty and Law

Cheryl Overs

June 2014 The IDS programme on Strengthening Evidence-based Policy works across seven key themes. Each theme works with partner institutions to co-construct policy-relevant knowledge and engage in policy-influencing processes. This material has been developed under the Sexuality, Poverty and Law theme.

The material has been funded by UK aid from the UK Government, however the views expressed do not necessarily reflect the UK Government’s official policies.

AG Level 2 Output ID: 232

SEX WORKERS, EMPOWERMENT AND POVERTY ALLEVIATION IN ETHIOPIA

Cheryl Overs

June 2014

This is an Open Access publication distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are clearly credited.

First published by the Institute of Development Studies in June 2014 © Institute of Development Studies 2014

IDS is a charitable company limited by guarantee and registered in England (No. 877338). Contents

Abbreviations and terms 3 Acknowledgements 3 Executive summary 4

1 The global context: poverty and sex work 6

2 The Ethiopian context 9 2.1 Economics and policies 9 2.2 Ethiopia’s legal system 10 2.3 HIV and AIDS 11 2.4 Civil society 11

3 Case study methodology 13 3.1 Limitations 13

4 Sex work in Ethiopia 15 4.1 Types of sex work 15 4.2 Economic policy and programmes for sex workers 15 4.2.1 Traditional associations 16 4.2.2 Faith-based organisations 16 4.2.3 HIV prevention and care programmes that target sex workers 16 4.3 Sex work and HIV 17

5 Information from sex workers 18 5.1 Law and policy 18 5.2 Violence and exploitation 19 5.3 Poverty and poverty alleviation 20 5.4 Health care 22

6 Discussion: the impact of policy, law and poverty on sex workers’ lives and livelihoods 23 6.1 Criminal law 23 6.2 Citizenship 24 6.3 Poverty alleviation programmes 25

7 Economic empowerment of sex workers: a risky but worthwhile business 28 7.1 Addressing complex interactions of poverty, choice, risk and circumstances 28 7.2 Pathways, roadblocks and wrong turns on the road to economic empowerment of sex workers 28 7.3 Lessons from successes and failures 29 7.4 Learning lessons, gathering evidence and building a community of practice 31

8 Recommendations 36 8.1 International 36 8.1.1 Map and evaluate economic existing empowerment policies and programmes for sex workers 36 8.1.2 Document evidence and develop a conceptual framework 36 8.1.3 Delineate sex work and trafficking 36 8.1.4 Identify structural determinants of poverty and develop policy to minimise them 36

8.1.5 Improve needs assessment tools 36 8.1.6 Ensure programme viability and scale 36 8.1.7 Improve planning and evaluation tools 37 8.1.8 Clarify HIV prevention and care goals 37 8.1.9 Observe and prevent harm 38 8.2 Ethiopia 38 8.2.1 Law 38 8.2.2 Policy 38 8.2.3 Programming 38

References 40

Boxes Box 1.1 Sex work, sex trafficking and sexual exploitation: different philosophies, different strategies 7 Box 1.2 Aims of economic empowerment programmes at a glance 8 Box 3.1 The sites 14 Box 5.1 Mobilising for safety and rights in Bahir Dar 19 Box 6.1 Having ‘the right papers’: a structural determinant of sex workers’ poverty 25 Box 6.2 Why economic initiatives for sex workers fail: key findings 27 Box 7.1 Economic empowerment – a risky business 30

Abbreviations and terms

ART Antiretroviral therapy ARV Antiretroviral CEDAW Convention on Ending Discrimination against Women CPU Child Protection Unit EEP Economic empowerment programmes FDRE Federal Democratic Republic of Ethiopia FGM female genital mutilation FHAPCO Federal HIV/AIDS Prevention and Control Office HEP Health Extension Programme Idir/iqub Informal community-based organisations IGA income generating activity Kabele/woreda Local government bodies in Ethiopia NGO Non-Governmental Organisations Nikat Nikat Women’s Association is an Ethiopian NGO established by sex workers NPUD National Policy on Urban Development PEPFAR US President's Emergency Fund for AIDS Relief RPAR Rapid Policy Assessment and Response STI sexually transmitted infection Timret Timret Lehiwot Ethiopia is an HIV/AIDS NGO based in Addis Ababa UN United Nations UNFPA United Nations Population Fund VEWEP Vulnerable Women Empowerment Program Wise Up National HIV prevention programme operated by US company DKT

Acknowledgements

The author would like to acknowledge the invaluable contributions of the women of Nikat, Beza Alemehayu, Henock Alemehayu, Associate Professor Bebe Loff, Nicholas Moody, Cassandra Van and Michael Williams. The author would also like to thank Timret Lehiwot, Vamp, Wise Up and Women’s Network for Unity for permission to use their photographs.

Executive summary

This case study explores economic, legal and social issues that affect sex workers, with a particular focus on the role of poverty in sex workers’ lives and the potential for poverty alleviation policies and programmes to help lift as many sex workers as possible out of poverty in order to reduce the exploitation, illness and violence associated with their work.

In surveys, sex workers overwhelmingly indicate they would like another occupation, particularly in very poor countries. This has been taken to mean that relieving the poverty of individual sex workers will lead them to stop or reduce sex work. On this analysis, reduced poverty will mean that the number of women entering the sex industry, or staying in it, will be reduced and/or that the harm associated with sex work would be diminished because the numbers of partners or of unprotected sexual contacts would reduce. However, the validity of this logic and the benefits, costs and consequences (intended and unintended) of poverty alleviation in the context of sex work have not been tested or even well documented.

Drawing on relevant international literature and field work conducted in three sites in Ethiopia, various types of economic empowerment programmes (EEPs) and policies were studied including income generating activities, social enterprise, microfinance, life skills and vocational training, buyers’ clubs as well as credit cooperatives and revolving welfare funds operated by governments, churches, public health agencies and sex worker communities.

Information about the EEPs and policies available is limited and no conceptual frameworks, overviews of policies or clear maps of how and where programmes operate and what outcomes they achieve have emerged. In the absence of such information, technical guidance, evaluation protocols or even accounts of best practice are also unavailable. Because successes, suboptimal outcomes and failures of policies and programmes are not well understood, opportunities to improve and expand them are missed and human rights abuses and other adverse consequences are not observed and documented.

This study addresses this dearth of policy guidance by providing empirical evidence and a corresponding set of policy recommendations at an international and national level to ensure that development programmes address poverty for all affected population groups, with a focus on sex work in Ethiopia.

Although adult sex work is illegal in Ethiopia the law is not enforced and sex workers are not subject to the levels of violence and extortion by police that have been widely reported in other countries. Further, although poverty and poor labour conditions for women clearly incentivise women and girls to sell sex, sex work does not in most cases provide a way out of acute poverty in Ethiopia.

Since 2012 the Federal Democratic Republic of Ethiopia’s (FDRE) policy on poverty alleviation has included sex workers. It funds traditional EEPs operated at a local level and allows HIV programmes and faith-based non-governmental organisations (NGOs) to operate EEPs in conjunction with other services, although their purpose is not articulated. On the other hand, the economic vulnerability that drives women into sex work and renders them liable to exploitation and abuse is made worse by policy that deprives women of legal recognition and therefore access to employment, education resources and services. Government policy also limits civil society engagement in advocacy, reduces the potential for sex workers to mobilise and obstructs institutional opportunities to address social, legal and economic issues around sex work.

Although the outcomes of the various EEPs for sex workers operating in Ethiopia are not reported, there is anecdotal evidence that they enhance sex workers’ livelihoods and form an

4 important gateway to accessing services and building social support networks. However, it is clear that the policy and the programmes do not lead to enough women leaving sex work to reduce the size of the industry and therefore the problems associated with it. There are a number of possible explanations for this, including: that places in EEPs are limited; that the enterprises the sex workers undertake lack viability; that EEPs do not provide sustainable, living wages; that programmes stigmatise women; and that collective economic activity may not be suited to communities characterised by mobility and lack of social cohesion.

The case study concludes with recommendations for Ethiopia and other countries. Primary among these is the need for a conceptual framework upon which to build policy and programming for economic empowerment. Such a framework should be grounded in human rights and cognisant of diverse aspirations and attitudes among sex workers of different backgrounds, and it should be based on a clear delineation between adult sex work, human trafficking and abuse of minors.

Research to produce knowledge about EEPs is urgently needed in order to learn lessons about how to develop, target, and monitor policies and programmes that are ethical, effective and large enough to matter. Such research should include thoroughly investigating existing initiatives and interrogating exactly how law and policy have enhanced sex workers’ livelihoods; the factors that determine programme success or failure; and the kinds of organisations and structures that can best deliver EEPs for optimal numbers of sex workers. With this data, much needed technical information could be developed to guide the planning, implementation and evaluation of EEPs and identify those policies that constrain sex workers’ economic opportunities.

Finally, the case study argues that sex worker involvement is key to advancing policy and programming that addresses poverty among adult sex workers. The best-sustained, most popular and apparently effective EEPs in Ethiopia and elsewhere appear to be those in which sex workers play a role in management and are not limited to being beneficiaries of schemes established and managed by others. Accordingly donors, UN agencies and government should invest in building sex workers’ capacity to design, implement and monitor EEPs and governments, including the FDRE, should ensure that sex worker organisations are able to operate freely and transparently in civil society.

Peer educators wear t-shirts to promote the economic empowerment component of a Ugandan HIV project and attract sex workers to its clinic. Photographer: © Cheryl Overs, 2009.

1 The global context: poverty and sex work

Studies of sex work in both wealthy and developing countries clearly support the intuitive notion that poverty and economic disadvantage propels women and girls into sex work, and many have found that poverty results in sex workers accepting money for unprotected sex (Sherman et al. 2010; Sahini 2008). From this emerges the idea that by alleviating girls’ and women’s poverty their need to sell sex will be reduced and, as a result, fewer women and girls will enter sex work and those who wish to leave will be more able to do so. This economic analysis and the subsequent responses to sex work take place in the context of recognition of the feminisation of poverty by key political and economic institutions including the World Bank, United Nations (UN) agencies and national governments, and an acknowledgement that gender inequality plays a significant role in the failure of traditional development and national economic programmes (World Bank 2001; Kabeer 1998). As this awareness has grown over recent decades, relevant policy and assistance programmes for women have been developed that aim to enable women to generate income, increase bargaining power, transform that bargaining power into desired actions and outcomes, build a savings base for emergencies, and avoid selling assets that may affect their future livelihood (AIDSTAR-One 2014).

By the turn of the century, gender-sensitive social protection, including insurance, labour market interventions and welfare payments or cash transfers, had been adopted as a key strategy by the World Bank and other influential agencies, and rolled out in many developing countries. As well as alleviating poverty, social protection policies also frequently aim to empower women in ways that will reduce domestic violence, food insecurity, child marriage, sex work, intergenerational sex, HIV and human trafficking (Devereux and Sabates-Wheeler 2007).

According to the UNAIDS Advisory Committee on Sex Work and HIV, economic empowerment of sex workers is an important strategy to improve sex workers’ living and working conditions:

By increasing economic options, sex workers can achieve greater financial security, which makes it easier for them to make important decisions that affect their lives. These include their choice of work and their capacity to save and plan for the future for themselves and their dependents. Improving economic options also helps sex workers to reduce the likelihood of having to accept clients’ requests for unprotected sex or that they will be put in situations that inhibit their ability to negotiate with clients and reduce the risk of violence or abuse. Economic empowerment means equality and equity within the financial system. There are considerable advantages in recognising that sex work is work, as this provides a framework within which sex workers can benefit from the same protections, including the same access to services and freedom from discrimination as other workers. (UNAIDS 2012: 21)

Although there is no map of EEPs for female adult sex workers, a search shows that hundreds of such projects operate across dozens of countries. They are operated by faith- based organisations, development NGOs, HIV projects, governments and sex worker collectives. Many are funded by national and international HIV programmes, the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the US Department of State's Office to Monitor and Combat Trafficking in Persons. USAID recommends microcredit for HIV prevention, a recommendation that includes sex workers in recognition that they usually lack capital, access to formal employment or verifiable creditworthiness (USAID 2010). Famously pioneered by the Grameen Bank in Bangladesh, microfinance aims to break the cycle of

6 poverty and multiply the options available to the poor through the provision of contextually appropriate financial services among the poor; microfinance can build the ability of the poor and unemployed people to create multiple employment and income opportunities (Getu 2006). This approach rapidly spread to other countries and to various populations (Bateman 2011). Box 1.1 Sex work, sex trafficking and sexual exploitation: different philosophies, different strategies

View 1. Prostitution is indivisible from trafficking because it is inherently violent and no woman consents to it. Clients and people who profit from sex work in any way are therefore rapists and traffickers and should be punished as such. This view is associated with radical feminist authors and has been adopted by the governments of Sweden and Norway which have made it illegal to buy sex.

View 2. Some adult women choose independently to sell sex and they should not be criminalised so long as they do not solicit in public or pay money to third parties (such as sex venue operators). However, some, many or most women who sell sex are coerced, recruited or forced into selling sex by poverty. This should be prevented by criminalising procurers, traffickers and exploiters. Women who have been forced, or who are selling sex reluctantly, should be offered rehabilitation. UN agencies and human rights organisations hold this view.

View 3. Sex work is a legitimate occupation and the sex industry should be governed by the same laws that govern other businesses, including the same laws and regulations that are used to prevent abuse and exploitation of adults and minors in other sectors. Anti-trafficking resources and criminal provisions related to human trafficking should be carefully targeted to only address child abuse and cases involving actual force. This is the position of the sex workers’ rights movement.

Despite the large number of programmes there are only two global reviews (Project Parivartan 2008; Greenall 2007). Both describe the elements of social protection for sex workers as vocational skills building, microfinance and social enterprise that directly generates income. Both observe that although the conceptual basis and aims of programmes are often not specified, in most cases the aim is for women who participate in them to stop selling sex. The reviews confirm our impression that outcomes of EEPs are rarely reported and that the broader impact has not been documented.

Most references to EEPs for sex workers are linked to internationally-funded HIV prevention and care for sex workers, although even there the economic element is generally dealt with as peripheral to reporting on the traditional public health components of HIV programming such as condom promotion, uptake of HIV tests or sexually transmitted infection (STI) treatment (Kennedy et al. 2014). The systematic review by Kennedy et al. of the impact of income generating programmes on HIV included only three accounts of projects targeted at sex workers (Kennedy et al., ibid.). Thus, despite considerable spending of HIV funds, EEPs among sex workers have not been included in authoritative literature or meta-analyses of HIV prevention interventions among sex workers (see, for example, the World Health Organization webpage on the topic in its HIV/AIDS Sex Work Toolkit (WHO 2005); and Bekker et al. 2014).

Nevertheless, the importance for sex workers of controlling economic resources, diversifying income sources, and increasing their capacity to absorb economic shocks or retire has been stressed by a number of authors and demonstrated by several projects (Binagwaho et al. 2010; Pronyk et al. 2005; Parker, Singh and Hattel 2000). An Indian study, for example, that showed increased economic independence was positively associated with control over both the type and cost of sexual services provided and condom use (Sherman et al. 2010).

Several case studies of EEPs suggest that such programmes can erode stigma and social isolation. For example, Ashodaya Samithi, a sex worker collective operates a restaurant in Karnataka, India, that was initially set up to meet sex workers’ needs for affordable meals

7 and now attracts a wide range of customers, generating funds that are used for activities within the sex worker community (World Bank 2010). Box 1.2 Aims of economic empowerment programmes at a glance ● Supporting and expanding women’s choices; ● Increasing condom use and therefore reducing HIV; ● Liberating women from sex work; ● Bringing women to faith and religious observance; ● Reducing human trafficking; ● Helping women feel more confident and more able to assert power in their social and private lives, i.e. ‘empowered’.

A Kenyan programme, KWVOC, operated by an HIV NGO, managed to set up two-thirds of 227 women enrolled in a two-year EEP that provided training and seed funding to begin businesses. Half of the women continued to sell sex but reported reductions in number of sex partners and more consistent condom use (Odek et al. 2009). In Mongolia and elsewhere there have also been reports of successful programmes, although they typically involve a very small number of women (Tsai, Witte and Aira 2011).

There are several peer-led EEPs in Africa, Latin America and Asia. For example, a sex worker collective operates a bar in Thailand1 and several sex workers’ NGOs in India, such as VAMP2 and Swathi Mahila Sangha,3 operate credit cooperatives, group insurance, income generating enterprises and job creation schemes. The largest and best-established of these is the Usha Multipurpose Cooperative Society which operates various kinds of financial services for 19,772 sex workers (verified membership 31 March 2013). It has successfully reduced sex workers’ reliance on loan sharks; increased members’ ability to send children to school; helped women to retire; and increased capacity to practice safe sex.4 Additionally, by working in conjunction with a sex worker-led Self Regulation Board, Usha supports rights- based responses to child sexual abuse and human trafficking. Using simple indicators such as the median age of sex workers in the area and the number of members in their savings cooperative (both of which have risen), Usha has produced measurable successes and displaced exploitative lenders.5

Selling condoms and beauty products in Addis Ababa. Source: © Wise Up, 2012.

1 See www.empowerfoundation.org/barcando_en.html. 2 Save us from Saviours website, see http://saveusfromsaviours.net/?p=28. 3 Swathi Mahila Sangha, see http://swathijyoti.com/. 4 See http://ushacoop.org/faq.php. 5 See Chowdhury (2013).

2 The Ethiopian context

2.1 Economics and policies The local economy and policy environment play an important role in determining how many girls and women sell sex casually or enter sex work, for how long they sell sex and in what circumstances. Ethiopia is one of the world’s poorest countries with a total population of 73.9 million, 50 per cent of whom are under the age of 18.6 Poverty is chronic and acute and particularly affects women and girls. From 1974 to 1991 Ethiopia was ruled by a military regime that left its economy in a state of collapse. From 1991 the government implemented a series of economic policies aimed at gaining the support of the international community and the Ethiopian people. This included shifting from a centralised or socialist economic system and adopting significant structural adjustment programmes. Subsequent governments issued a series of Policy Framework Papers outlining what the government calls a ‘pro-poor policy stance’ that is consistent with global acknowledgement that safety nets are needed to protect the most vulnerable from the negative consequences of such economic reform programmes (Social Watch 2001). After 2001, Ethiopia became an essential ally of America in the ‘war on terror’ and began to enjoy what The Economist described as ‘unstinting praise’ from the Bush administration (The Economist 2007).7 Since then, its national Growth and Transformation Plan has achieved high single-digit growth rates through government-led infrastructure expansion and commercial agriculture development, making Ethiopia one of the fastest- growing economies in sub-Saharan Africa (Nganwa 2013; CIA 2012). However, the largely subsistence economy remains incapable of producing the hundreds of thousands of jobs needed every year just to keep up with population growth (CIA 2012).

The Constitution provides that women have equal rights with men. It also states that the historical legacy of inequality and discrimination suffered by women in Ethiopia is taken into account, and in order to remedy this legacy women are entitled to affirmative measures.8 The purposes of such measures are to enable women to compete and participate on an equal basis with men in political, social and economic life as well as in public and private institutions.9 This has not been realised, possibly because the gender-based division of labour and lack of access to and control over resources are prescribed not only by tradition and culture, but also reiterated in the law (WomenWatch 1997-2008). It was not until 1997, for example, that women were able to lease state-owned land. The maternal mortality rate is extremely high, in part due to lack of obstetric care, food insecurity, taboos, poverty, early marriage, and birth complications related to female genital mutilation (FGM). Households headed by single women are vulnerable to food insecurity, infant mortality and other symptoms of chronic acute poverty (Assefa 2004). In some parts of the country, as many as 30 per cent of households fit this profile (Meehan 2004).10

A range of gender-specific poverty alleviation programmes are in place, as well as policies to ensure that women benefit from the central Growth and Transformation Plan (Nganwa 2013). These include social protection programmes that provide resources to the poor through public works and direct support, and the Ethiopia Joint Programme on Gender Equality and Women’s Empowerment led by UN Women and the UN Population Fund, which leads microenterprise and capacity building for livelihoods (UN Women 2013). Other poverty alleviation policies include the Health Extension Programme (HEP) that provides free services and a range of basic health interventions; the National Nutrition Programme and

6 Ethiopia ranks 169 out of 177 on the UNDP Human Development Index. 7 The flow of aid was temporarily slowed after 2005 when elections in Ethiopia were marred by mass killings of opposition supporters and other protesters, and thousands were rounded up and jailed in subsequent crackdowns. 8 Article 35, The Constitution of the Federal Democratic Republic of Ethiopia, 1995. 9 Article 33, ibid. 10 The maternal mortality rate is extremely high due, in part, to lack of obstetric care, food insecurity, taboos, poverty, early marriage, and birth complications related to FGM. See www.afrol.com/Categories/Women/profiles/ethiopia_women.htm.

Action Plan; and the National Policy on Urban Development (NPUD) of which housing for vulnerable people is a component. Local government grants waivers to vulnerable people to allow them access to health services and services related to communicable diseases such as TB and HIV/AIDS. Services such as immunisation, maternal and neonatal health care are provided free of charge.

2.2 Ethiopia’s legal system Ethiopia’s legal system incorporates socialist principles, the civil law of the nineteenth century European powers and traditional law. In 1995 a new Ethiopian Constitution was introduced.11 It incorporates human rights provisions from the Universal Declaration of Human Rights of 1948 and confers all land ownership to the state and obligates it to provide long-term leases to citizen tenants. The commercial law regulates all commerce and business activities12 and registration is compulsory for all business persons, business organisations and traders. However, the law does not recognise all of those conducting business or selling their labour as traders. Pastoralists, fishermen, street traders and many other occupations are excluded. Anyone who is deemed to be ‘incapable’ is prohibited from carrying on a trade, and where they do it is unlawful. The Labour Proclamation law protects and regulates the rights of people who are categorised as ‘workers’, while clearly stipulating the limited definition of the term ‘worker’.13

Although the law does not prohibit prostitution itself, the associated activities of brothel keeping,14 trafficking and public soliciting15 are illegal. All penalties are higher where minors are involved. The terminology of the relevant legislation is broad. Article 634 of the Criminal Code criminalises exploitation for pecuniary gain16 and Article 846 addresses immoral commercial soliciting as well as ‘debauchery’.17 (This provision is not gender specific so ‘improper soliciting’ could apply to the buyer as well as the seller.) Sexual and obscene acts or gestures are prohibited by the Public Indecency and Outrages against Morals Act18 and a proclamation that criminalises vagrancy.19 A person commits an offence where he acts or refrains from acting in a manner or in conditions which offend morality or public order.20 Some law relates to sex and labour trafficking and slavery (Articles 635, 596 and 597) and they carry severe punishments. Article 598, Unlawful Sending of Ethiopians to Work Abroad, and Article 571, Endangering the Life of Another, could apply, but according to the US Department of State it has been used only in relation to transnational labour trafficking that is unrelated to sex work (United States Department of State 2010).

The law clearly states that, ‘a contract shall be of no effect where the obligations of the parties or of one of them are unlawful or immoral’.21 This matches public morality provisions of the Constitution and means that sex workers cannot make legal contracts or benefit from the legal protections available to others.

Central government has not issued official or written policy on enforcement of prostitution laws but it appears that an unofficial policy is in place throughout the country to tolerate sex work and to limit law enforcement to where there are serious complaints, disturbances or abuse of minors.

11 Article 9, ibid. 12 Article 100 of Commercial Code of the Federal Democratic Republic of Ethiopia. 13 Article 4, Labour Proclamation (No. 373/2003) of Ethiopia. 14 Article 604, ibid. - Habitual Exploitation for Pecuniary Gain: ‘Whosoever, for gain, makes a profession of or lives by procuring or on the prostitution or immorality of another, or maintains, as a landlord or keeper, a disorderly house [brothel], is punishable with simple imprisonment and fine.’ 15 Article 846, ibid. - Immoral Soliciting and Debauchery. 16 Article 634, The Criminal Code Of The Federal Democratic Republic Of Ethiopia (Proclamation No. 414/2004). 17 Article 846, ibid. 18 Article 639, ibid. 19 Vagrancy Proclamation No. 384/2004 of Ethiopia. 20 Article 2030, The Civil Code Proclamation of 1960. 21 Article 1716, ibid.

2.3 HIV and AIDS An estimated 1.1 million people are living with HIV in Ethiopia, which means it is one of the most severely affected countries in the world. The epidemic took hold very quickly and by 2009 HIV prevalence was estimated to be 2.8 per cent. More recently, strong signs have emerged that HIV is declining significantly as a result of improved prevention services and expanded access to antiretroviral (ARV) treatment.22

HIV care, like other health care including maternal and sexual and reproductive health services, is delivered by NGOs and in public hospitals and clinics that are administered by local authorities (called woredas or kebeles). Although the system is not identical throughout the country, most keep a list of local people entitled to receive medical treatment at public hospitals and clinics. Both HIV testing and ARV medications are free and accessible to those who can attend clinics. No identity card or local patient registration is required. The patient’s occupation is not requested or recorded in the notes of patients at HIV counselling and treatment clinics.

2.4 Civil society Although Ethiopia has a history of traditional charitable and welfare activities, legally recognised NGOs are a relatively recent development. Modern civil society organisations were first established as faith-based organisations in the 1930s and welfare organisations like the Red Cross started to operate in Ethiopia in the 1950s (International Center for Not- for-Profit Law 2014). By 2009 there were reportedly 3,822 registered NGOs (Lei Ravelo 2013). In 2009, a law named the Proclamation on Charities and Societies P621/2009 was passed.

The new law governs how the NGO sector can deliver services and address human rights issues in the country. It imposes requirements for NGO registration including the need to obtain a letter of recommendation from the Ministry of Foreign Affairs; places strict limits on the portion of funds that can be used for administration; and bans NGOs that receive more than 10 per cent of their funding from foreign donors from promoting human rights, the rights of children and persons with disabilities, or social justice. The aim is to develop financial self- sufficiency and independence from foreign donors but the policy has been widely criticised and is considered to create ‘a very restrictive environment for human rights defenders and seriously impairs the independence of civil society’ (Yntiso Deko 2012; International Federation for Human Rights 2009). As a result of the law, the number of NGOs is said to have reduced to approximately 1,500 (Lei Ravelo 2013). The policy has meant that NGOs have a better chance of survival if they raise a portion of their operating funds by organising programmes that generate income for both their operating costs and individual beneficiaries.23 Thus income generating activities have become a necessity for NGOs if they are to survive and there is strong incentive to avoid any activities that the government could interpret as human rights advocacy. This law and government policy on civil society which is purportedly to prevent foreign control and ensure transparency within the NGO sector is highly controversial. It has come under intense criticism for its association with repression of freedom of speech and its impact on human rights advocacy. The UK government and DFID in particular have been targeted for failing to take action to ‘break the links between aid and repression’ (Porteous 2010).

As well as this restriction that applies to all civil society organisations, sex workers’ ability to mobilise around rights issues is also constrained by older limits on NGO registration. If the government considers that an NGO is likely to be used for unlawful purposes or for purposes

22 ‘Between 2001 and 2005, the number of AIDS deaths declined by 21.9 and 9.3 per cent for men and women, respectively. Between 2005 and 2007, the number of AIDS deaths declined by 38.2 for men and 42.9 per cent for women’ (Reniers 2009). 23 Executives who allocate more than 30 per cent of their budget to administrative expenses are subject to fines or imprisonment.

11 prejudicial to public peace, welfare or good order in Ethiopia, registration is refused; so, too, if the aims or name of the charity or society is, in the opinion of the government, contrary to public morality. In practice this has not prevented sex worker groups forming community- based organisations and registering, but it means the ability of those organisations to address human rights issues is limited.

3 Case study methodology

Literature reviews and desk research were conducted to gather information about the economic, policy and legal environment in Ethiopia, and economic empowerment programming among sex workers in Ethiopia and internationally. The perspectives of sex workers and other key informants were gathered using an adapted version of the Rapid Policy Assessment and Response (RPAR) (Sobeyko et al. 2006; Temple University 2006).

A partnership was established with an Addis Ababa-based sex worker group, Nikat, and the NGO Timret that operates sexual health services and education for sex workers throughout the country. Timret arranged in-country logistics including arranging and facilitating interviews during the fieldwork. Five small group interviews24 with 53 adult female sex workers took place in Addis Ababa, Shashamene and Bihar Dar in mid-2011. Both individual interviews and small group interviews were semi-structured, using an interview guide containing mainly open-ended questions and some prompts for the interviewers to keep the discussion on topic. In addition to the small group interviews in these three sites, additional interviews took place with four activists from the sex worker organisation Nikat: the director of the Wise Up programme; two local public prosecutors, a police officer and a representative of the Ministry of Women’s Affairs.

3.1 Limitations Information for this case study was gathered through a structured consultation rather than scientific research. The women interviewed in small groups were asked to describe and provide impressions and perceptions about the environment rather than share specific information about their own lives or experiences. This enquiry was conducted in urban sites. Although many participants were from rural settings, the conduct and policing of commercial sex among Ethiopia’s large rural population were not explored. (See Box 3.1 below for a description of the sites.)

Particular practical and ethical constraints associated with interviewing marginalised women in Ethiopia were considered and discussed with partners. An assessment was made that revealed that there was no risk of women being subject to arrest, violence or other abuse as a result of attending a small group interview. Each place that the group interviews were held was accessed by sex workers on a daily basis and no such problems had ever occurred. Another consideration was that since most participants live on daily subsistence, participation in such a group takes them away from their daily income. Food and travel expenses were provided.

Particular consideration was given to participant consent. The purpose and nature of the research was explained at the outset of each small group interview. After an opportunity for questions, a break was taken. Those who wished to participate were invited to return after the break. Permission was sought to copy and distribute all images of adults, notes and other information gathered during the consultation. No images of children were recorded and no children were present during group interviews.

The case study addressed female but not male sex workers because that is the definition of sex workers used by the Ethiopian government HIV programme, the UN and NGOs. To include male sex workers, a substantial increase in budget and time in the field would have been needed.

24 For convenience these are referred to throughout this paper as ‘the groups’.

Box 3.1 The sites

Addis Ababa is a modern urban capital and significant centre of trade, industry and tourism in the region, and the base of the African Union. The city has a population of approximately 3 million including immigrants from other parts of the country, and regional and foreign residents connected to trade and aid agencies. The sex industry in the capital takes place openly in bars, massage parlours, brothels, in the main streets, hotels of all standards, and pastry shops and small establishments that sell araki (local brew) and khat (leaf chewed as stimulant).

Shashamene is a town 250 kilometres from Addis Ababa in the Oromia Region where all the main highways intersect. It has an estimated population of 94,000 people. Although all forms of sex work take place in Shashamene, bar-based sex work is most common followed by araki and shisha smoking houses. Home-based sex work is not known in Shashamene. Most women who work in the town’s many sex venues are from other places.

Bahir Dar is the capital of the Amhara Region, 560 kilometres north from Addis Ababa. It has a population in excess of 200,000 and is adjacent to Lake Tana, which is an international tourist destination. It has two large universities and a market.

4 Sex work in Ethiopia

4.1 Types of sex work Sex work was last mapped in Addis Ababa in 200225 where it was estimated that there were 8,134 establishment-based sex workers and 250 street-based sex workers (Family Health International 2002). However, it is clear that, if these figures were correct at the time, the population has grown significantly since then. Sex work in Ethiopia is vast, diverse and conducted openly. Sex workers operate in virtually all hotels, bars and restaurants and there are street workers on most main roads of towns after sunset. Throughout towns and cities sex workers and clients meet at informal bars that sell the local brew, araki. Both sex and araki is sold from single room households where women live alone or with their children. In some towns these are clustered in slum areas where sex work is practised explicitly by most of the resident women. In 2010 the government agency for HIV/AIDS, Federal HIV/AIDS Prevention and Control Office (FHAPCO), said that the size of the sex worker population is not known but it was suspected that the number of sex workers is growing (FHAPCO 2010).

The Lonely Planet Guide is more blunt:

Almost 100 per cent of the women encountered in smaller bars, restaurants and nightclubs of the capital and towns are prostitutes. Often it’s very hard to distinguish them from ordinary women... The social stigma attached to prostitution in the West is lacking in Ethiopia. (Linzee Gordon 2000)

While it is certainly true that commercial sex is freely available throughout the country and that stigma against sex workers is less pronounced than it is in some other countries, sex work certainly is stigmatised in Ethiopia. The tourist’s-eye view misses the fact that the majority of sex workers travel away from their place of origin to sell sex. Both the literature and the information provided by women suggests that a combination of stigma associated with promiscuous sexual behavior and poverty combine to incentivise girls and women to leave towns and rural settings for other towns or cities where they immediately or eventually, join the sex industry (Van Blerk 2007).

Trafficking is not considered to be a significant feature of the sex industry. According to the US Department of State’s 2010 Trafficking in Persons Report, ‘girls from Ethiopia’s rural areas are exploited in domestic servitude and, less frequently, prostitution’ (United States Department of State 2010).

4.2 Economic policy and programmes for sex workers The history of official policy on poverty alleviation for sex workers is short. In 2012 the government Social Protection Policy included sex workers for the first time.26 The economic empowerment interventions recommended by the policy for vulnerable groups are microfinance services, skills training and conditional and nonconditional social transfers.27 In practice, the programmes available fall into three main types.

25 Unfortunately there is no national map or reliable estimate of the size of the sex worker population in Ethiopia. 26 ‘Social protection actions will focus on the elderly, labour constrained individuals and households, people with disabilities, pregnant and lactating women, persons living with or directly affected by HIV and AIDS and other chronic debilitating diseases, vulnerable children, the unemployed… and victims of social problems (such as drug use, beggars, victims of trafficking and commercial sex workers)’ (Federal Democratic Republic of Ethiopia Ministry Of Labour and Social Affairs 2012: 16). 27 For more information on social transfers see ILO (2014).

4.2.1 Traditional associations There is largely undocumented history of sex workers benefiting from traditional economic self-help associations for very poor people called iquibs and idirs. An iquib is an association established by a small group of people in order to provide sustained revolving funds for members. An idir is an association that raises funds for its members. The idir is a long-term association and the iquib can be temporary or permanent, depending on the needs of the members (Tirfe 1999). Local government (kabeles and woredas) or local industry provide groups with buildings and equipment to begin small farms, shops and other businesses. This system pre-dates modern poverty alleviation programmes and has been described as a form of group insurance and is credited with being ‘among the most enduring, universal, effective, and relevant socio-economic informal institutions Ethiopians have created’ (Bekerie 2003). Sex workers have formed idirs and individual sex workers have joined local idirs. Unfortunately the extent to which this happens and the specific outcomes for beneficiaries are not documented.

4.2.2 Faith-based organisations Several organisations operate projects that aim to save women from sin or human trafficking (Getu 2006). The most prominent is an NGO named Women at Risk, which is funded by donations from US-based Christian organisations.28 It manufactures goods that are sold through US-based Christian social enterprise websites.29 It is not known if these programmes are evaluated or monitored but, if they are, the reports are not publicly available.

4.2.3 HIV prevention and care programmes that target sex workers These support NGO partners to distribute condoms and promote sexual health and, in addition, to conduct income generating activities for some of the programme beneficiaries. The activities are similar to those performed within idirs, although the shorter funding cycles mean that they do not typically involve complex infrastructure or complex capital investment. The number of these projects and their outcomes are not collated but individual results are monitored and included in reports to donors (see, for example, an account of Nikat in Muletta 2012).

These three categories are not mutually exclusive and some organisations draw on elements of two or all three of them. For example HIV, anti-trafficking and faith-based organisations organise sex workers into idirs or other groups that can access local and international resources.

The enterprises these groups undertake are referred to as ‘income generating activities’ (IGAs). Income from them is directed to both the individual beneficiaries and, in some cases, to an NGO that has organised the group or activity.

28 See Women at Risk website, www.w-a-r-e.org/history.html. 29 Live Fashion at http://livefashionable.com/products/; Samaritan’s Purse at www.samaritanspurse.ca/rss/healthy-children- healthy-families/africa/new-beginnings-for-women-escaping-prostitution-in-ethiopia.aspx; The Keziah Project at http://unadopted.org/ethiopia/#sthash.D2dGcTlX.dpuf and the Mocha Club at www.themochaclub.org/projects/economic- freedom/.

Income generating idir: sewing in Addis Ababa. Photographer: © Timret Lehiwot, 2009.

4.3 Sex work and HIV In 1996 the government recognised female sex workers as a population at high risk of HIV and increased research and intervention efforts targeting them (Federal Democratic Republic of Ethiopia Ministry of Health/FHAPCO 2005). In 2006 the National Reproductive Health Strategy similarly recognised sex workers as one of the populations at risk (Federal Democratic Republic of Ethiopia Ministry of Health 2006), as did FHAPCO in its 2010 report on the implementation of the UN Declaration on Commitment on HIV/AIDS. As a result of these policies, sex workers’ access to HIV prevention, care and treatment services has increased through a network of drop-in centres throughout the country offering advice, condoms and income generating activities. Both HIV testing and ARV treatment are free in Ethiopia and accessible to those who can attend clinics. Crucially, they are available to people who have migrated internally or who do not possess a national identity card which, as is discussed below, is needed to access many services as well as accommodation and employment.

Despite this progress, the role of commercial sex in the Ethiopian HIV epidemic is not well understood. 2009 data from a mobile testing unit in 40 towns along the major transportation corridors found that 25.3 per cent of the sex workers tested were HIV-positive, although this is unlikely to be representative of sex workers throughout the country (Federal Democratic Republic of Ethiopia Ministry of Health 2009). Condom use has risen significantly, from 5.3 per cent in 1989 to 91.6 per cent in 2005, to 99.4 per cent in 2008 (Federal Democratic Republic of Ethiopia Ministry of Health 2008). Increased access to HIV treatment means that sex workers who have tested HIV-positive are receiving ART and are therefore unlikely to transmit the virus (Kayitenkore et al. 2006). A 2010 government report claims that condoms are used in 99 per cent of commercial sex (FHAPCO 2010). The report also suggests that, among sex workers, higher rates of HIV infection are associated with increasing age (probably associated with longer duration in sex work), marital status (higher among divorced/widowed), place of work (among those working in bars/hotels), the presence of active syphilis and other STIs, higher numbers of sexual partners and inconsistent condom use (Federal Democratic Republic of Ethiopia Ministry of Health 2008).

5 Information from sex workers

The following are reports of the small group interviews with groups of sex workers in each site. The participants were recruited through Nikat and the Timret Lehiwot. Because those organisations reach most sex workers in each site through the national HIV prevention programme Wise Up, the groups were considered to be capable of providing the overview of the local situation. Of the 54 participants, all said they were Ethiopian except one Eritrean and one Somali. The discussions lasted approximately two hours. The topics explored included law; policing practices; conditions in the sex industry; health issues; poverty and poverty alleviation; human trafficking; and violence.

5.1 Law and policy The first issue discussed was the legal status of sex work and policies that affect sex workers. Levels of understanding of the legal status of sex work varied. Some suggested that sex work could not be illegal because, if it was, it could not be practised openly and without police interference. Some incorrectly thought that conducting another trade alongside sex work, such as waitressing, means that the laws against prostitution do not apply. Others said that they had been told that there are licences that exempt some venues from laws concerning brothel keeping and living off immoral earnings (there are no such licences). However, many participants had an accurate understanding that there are some laws against soliciting and brothel keeping. Most said they were aware that it is illegal for minors to sell sex and for others to exploit children sexually. However, only in one of the sites (Shashamene) had any of the participants heard of a case of formal charges laid and that was in relation to the sexual exploitation of minors.

Participants in each group were unanimous that police usually ignore sex workers. In all sites, police visit bars and other places of prostitution as customers relatively openly, and sometimes even in uniform. No participant in any of the groups reported any personal experience, or knew of a sex worker or other person involved in the sex industry having been charged with a prostitution-related offence. Participants in the Addis Ababa group said that crackdowns against street sex workers do occur, usually associated with key dates in the government calendar such as meetings of the African Union or elections. Even then, the police mainly move women on rather than arrest them.

There was strong agreement in all groups that bribes are not paid to police in order to escape arrest, as has been reported in many other countries (Family Health International 2002). Exceptions to this were mentioned in two Addis Ababa groups in which women cited payments as low as 30p to local police which may be seen more as a tip than a bribe to avoid arrest. (This contrasts markedly with the findings of a similar study in this series in Cambodia (Overs 2013), as well as other literature on sex work (see website of Network of Sex Work Projects, www.nswp.org).

Discussions about law enforcement led to expressions of concern about the number of children involved in the sex industry and lack of enforcement to prevent it. Many suggested that older minors (16- to 18-year-olds) are found in large numbers throughout the country. This was attributed to demand for young girls and many girls and women wanting to escape rural poverty. The predominant view was that once a girl or a young woman has found herself in sex work, she is most likely to prefer to keep doing it for the relative economic security and freedom it offers compared to other occupations like domestic work or daily labour. Indeed, while not approving of the involvement of minors, some commented that because this had been their experience they were unwilling to condemn subsequent generations of young women for making the same decision, including in some cases their own daughters. Expectations of law and citizenship rights were perceptively low among most

18 participants, which is consistent with Ethiopia’s human rights record and status in respect of rule of law.30

5.2 Violence and exploitation Each group discussed the use of coercion, trickery or violence to recruit girls and women into the sex industry or keep them in it against their will. In all groups there was unanimous agreement that this is rare because employers don’t need to use those tactics to acquire or retain sex workers. According to each group, women’s employment is so poorly paid and women workers so badly treated that sex work can actually be a less exploitative or violent option than other available choices. One woman in Addis Ababa said of coercion, ‘it probably happens but none of us have ever seen it or known anyone in that situation.’ Another, in Shashamene, said she had been tricked into sex work by a man she thought was taking her to a town to become a domestic worker. She added that although she arrived that way she had chosen to stay to work in a bar when she had ‘gotten rid of him’ because it offered relatively satisfactory work conditions. Other women recognised that false promises of jobs may feature in the procurement of girls from rural areas and a couple commented that girls from pastoralist families who have lived in rural isolation and not been to school have so little information about any aspect of life that they are easily tricked, especially if the procurer is a trusted local person.

When asked about who had power over sex workers, all groups immediately identified bar owners and sex venue operators and, to a lesser extent, clients. All agreed that conflict with police is most often a result of disputes about prices, payment, services, condom use and accusations of robbery. It is routine for police to mediate disputes, either on the spot or by taking everyone involved to the police station where they decide how the dispute will be resolved (usually by one party paying the other as compulsory restoration or compensation). In both Shashamene and Bahir Dar older participants strongly agreed that these disputes involving police used to almost invariably lead to police taking the man’s side and possibly beating the ‘unruly’ sex worker/s but that this has declined markedly since policy and programming improved in 2009 when the Wise Up programme was established. Box 5.1 Mobilising for safety and rights in Bahir Dar

A slum called Koshi Kosh in Bahir Dar functions as a ‘red light’ district. The community of sex workers there has mobilised to unite against violence by engaging with local police to protect sex workers and their children and bring order to the environment by forming a committee that performs ‘overall peace keeping activities’. It aims to prevent minors, violent men and sexual abuse from entering the area and encourages condom use by clients, including offering support to women who want to eject men who refuse to use condoms. The idea for this self-help approach was developed by sex workers and a female police officer, Sergeant Metaket Ferede, in the local Children and Women Protection Unit. The policewoman said that women’s rights can only be protected and ensured when all women, including sex workers, are protected by the community in general and governmental bodies in particular. She also said the women were increasingly taking the much- needed step of empowering themselves and taking more responsibility for their environment, ensuring that children are not abused and minors do not engage in sex work.

Rape by police was also described as rare and no group raised, or recognised when prompted, the systematic violent rape of sex workers reported in other countries (see, for example, Jenkins 2006). Although there were some anecdotes about violence by police there was a clear indication from each group that it is rare. All groups said that it is relatively

30 Several indices rank countries for corruption, human rights abuses, rule of law and failed state status. Ethiopia consistently ranks poorly on all of them. For example, it is 113th on the Transparency International Corruption Index and ranks just above Zimbabwe in the World Justice Program rule of law ratings, worldjusticeproject.org/rule-of-law-index. Ethiopia ranks 17th in the 2012 Failed States Index released by the magazine Foreign Policy and The Fund for Peace, www.tesfanews.net/ethiopia-ranks- 17-in-failed-states-index/.

19 common for men to bring girls and women to work in sex venues in exchange for a fee paid by the venue operator.31 The Shashamene group explained that in a few cases arrangements between the procurer and the bar owner oblige sex workers to stay for a set time and that if they want to leave the procurer clears it with the bar owner, usually by providing a replacement.32

Participants in each group who had been working in the sex industry for some time said that violence was far more prevalent before the establishment of the Wise Up programme in 2009, which came in the wake of the government designating sex workers as a ‘Most at Risk’ group in its 2006 AIDS policy (FHAPCO 2010). Wise Up trains police, raises awareness of rights and provides direct support to sex workers at police stations throughout Ethiopia.33

5.3 Poverty and poverty alleviation Group discussions about trafficking and forced prostitution rapidly segued into discussions about economic conditions and women’s poverty. One woman in Addis Ababa answered the question about forced prostitution by looking incredulously at the foreign consultant, pointing to the window and saying, ‘Have you seen the living conditions around here?’ Others pointed out that girls and women are so poorly paid that maids often escape to sex work as a less exploitative and violent option than domestic work. Domestic workers are so likely to experience sexual exploitation that they are targeted as an HIV risk group (DKT/IRIN News 2010; Agustín 2009). This of course inverts the normative discourse in which sex work is the occupation to escape.

Significantly, there was agreement that sex work does not provide a route out of poverty or even significant relief from poverty as it does in wealthy and middle income countries. One woman offered an analysis: she said that broader economic conditions generate and sustain an oversupply of sex workers competing for the custom of clients who are also poor. This, she said, created a ‘buyers’ market’ in which many women chase each client to offer services that are very cheap even by local standards.34

Most of the women in the groups were participating, or had participated, in an income generating activity. In some cases the projects were cooperatives set up by the Wise Up programme or other HIV NGOs. In other cases they were members of idirs (see above Sections). No participants were involved in income generating activities operated by religious NGOs but some were aware of them. Most said the income generating activity had been very beneficial and there was agreement in all the groups that the IGAs are worthwhile. A woman living with HIV who worked in a restaurant said working in a bakery where lunch was served fulfilled the nutritional needs of her and other members of her group of women living with HIV.

The most frequently raised concern about the IGAs was the difficulty of finding markets for goods and services. Some participants said it is difficult to see IGAs as successful if success is defined as members completely stopping sex work. All said the extra income derived from IGAs was useful.

The Wise Up coordinators in Bahir Dar and the Wise Up director commented that IGAs are most needed by the oldest and the youngest sex workers. This was echoed by a woman who

31 A key informant said that it is common for rural women to seek out brokers who are able to help them relocate to a city for all types of work. 32 Although this does not involve sex without consent this arrangement may constitute trafficking depending on how trafficking is defined. 33 Two recent studies of violence against sex workers in Ethiopia found higher rates of violence than suggested in these groups (Mooney 2013; Teferra 2012). Whether this is attributable to different interventions, changes in conditions nationally, other local conditions or methodological shortcomings, the disparity is worthy of investigation. 34 Locals usually pay between US$0.20 and US$5 for sex while foreigners in Addis Ababa pay a little more. Some participants commented that foreigners from other African countries or the Ethiopian diaspora negotiate hard to pay the local price. None had access to non-African clients.

20 commented that she was pleased to be able to bring her daughter who was beginning sex work to the IGA. As a sex worker herself, she said that it is difficult to find ways to try to point her daughter in ‘better directions’. Some women commented that places in IGAs are difficult to secure and others mentioned that income generating cooperatives can only support a very limited number of members. There was also discussion about the need to be careful about joining schemes whose success depended on other sex workers not being lazy, greedy or dishonest. Some women shared anecdotes about their contributions having been wasted as a result of business failure due to the bad behaviour of other women.

The theme of bad behaviour was also taken up by the Women’s Affairs Officer interviewed in Bahir Dar. She noted the tendency of sex workers’ IGAs to flounder, noting that sex workers often sell the materials granted by IGAs and return to sex work after short vocational training because it does not lead to jobs or enterprises from which they can fully support themselves and their families. But a sex worker activist interviewed alone attributed this to mismanagement and poor planning within the programmes themselves. She said she is interested in income generating activities but not training. She said, ‘every NGO has a room for hairdressing or sewing training and a computer room but there is no money for teachers and no jobs afterwards. Cooking injarras [a large pancake] was best for me because I had money from it each day I went there’. Some women said they were annoyed by NGOs talking about IGA opportunities and seeding grants to start businesses that failed to eventuate.

Several women and other interviewees identified access to an identity (ID) card as a tangible benefit of participating in an EEP. Local authorities accept the address of the IGAs for the purposes of acquiring an ID card (discussed further below, and mentioned briefly in Miller 2010). Other motivators include the opportunity to spend time doing something worthwhile and eat in the company of other sex workers. In this sense, the IGAs operate as safe spaces. One of the leaders made a point of saying, ‘by this we mean a space in which sex workers will neither be judged nor attacked. Sometimes being judged hurts just as much’.

Nikat income generating activity: cooking injarras, Addis Ababa. Photographer: © Cheryl Overs, 2009.

5.4 Health care When health care was raised in each group participants commented unanimously that access to primary and secondary health care is expensive and inaccessible for all poor Ethiopians. The majority of participants said that all of the sex workers they knew used free government clinics rather than the private sexual health clinics such as Marie Stopes. Distance to clinics and the price of medications and contraceptives were cited by some women as barriers. The exception were HIV services which are free. Most participants reported little or no discrimination in HIV services and reported feeling comfortable about attending clinics for voluntary HIV testing, counselling and treatment. Some said that although the initial tests and antiretroviral treatment are free, several other important components of HIV care and treatment were expensive, missing or inconsistent.

No coercive HIV testing or STI screening was reported and comments about health workers were generally favourable. All groups agreed that HIV discrimination has reduced in recent years, although most HIV-positive participants said that ‘don’t ask, don’t tell’ continues to be their main approach and one women said ‘secrecy is the main strategy for avoiding discrimination’. Disclosing HIV-positive status remains difficult, especially where there is a risk of subsequent loss of livelihood.

6 Discussion: the impact of policy, law and poverty on sex workers’ lives and livelihoods

6.1 Criminal law Although Ethiopian law contains a range of provisions that could be used against the sex industry, they are not enforced. Unlike countries in which criminalisation and corrupt law enforcement lead to violence and exploitation, in Ethiopia there is no evidence of routine coercion or violence or of bribes being routinely paid to police. Although there is some domestic human trafficking it does not usually involve the extreme violence associated with trafficking in other parts of the world, possibly because chronic, acute poverty means there is a steady flow of girls and women willing to travel to earn money however they can.

The high levels of violence and exploitation that are routinely reported in countries where harsh law enforcement forces sex workers to accept the ‘protection’ of sex business operators are not evident in Ethiopia. Sex workers and clients who have met in bars or other public places can usually access clean and relatively safe places to have sex and sex workers are not routinely exposed to violence and arrest or to extortion. There is no sense that lack of enforcement of the sex work law leads to public disorder, drugs or other secondary crime. Participants attributed this to a combination of the police possessing enormous authority as agents of an authoritarian state and to religious and cultural constraints. However, there is one significant aspect of lack of policing. Despite clear penalties in the criminal code against sex with minors, there is little incentive for bar and brothel owners to avoid exploiting underage girls because they can be relatively confident that there will be no consequences if they do.35 The women in the groups said unanimously that the laws in relation to minors should be properly implemented but several were adamant that, to significantly reduce sexual abuse, young teenagers involved in commercial sex must be provided with services, education and jobs.

There are no legal barriers to possessing condoms or accessing health care and government policy is geared towards increasing access. However, as elsewhere, sex workers in Ethiopia experience labour violations such as long hours, unsuitable conditions and the extortionate prices for accommodation, transport and other living expenses charged by some employers. Many have to work long unpaid hours waitressing in restaurants and bars in exchange for access to clients. Complaints also include being required to work while menstruating and being pressured to perform oral sex, which participants almost unanimously saw as taboo. At the same time, participants expressed overall satisfaction with the willingness of clients to use condoms and opportunities to choose between working ‘freelance’ or for a third party. The majority view was that in most cases the division of money between sex workers and venue operators is acceptable. A substantial part of the Ethiopian sex industry operates by the brothel or bar and the sex worker splitting the money paid by the client on a 50/50 basis. Street and home-based workers can keep as much as 80-100 per cent of what the customers pay.

35 Ethiopian Criminal Code 2004 Article 626 and 627 – Sexual Outrages on Minors between the Ages of Thirteen and Eighteen Years; and more severe penalties for offences where the victim is a child in other provisions of the same Act.

6.2 Citizenship The policy that most affects sex workers’ economic and related outcomes in Ethiopia is the requirement that citizens register with their local kabele which controls access to resources, services and civil functions.

This relationship between the citizen and the state is described as ‘recognition of personhood before the law’ and in Ethiopia it is expressed through possession of an ID card. ID cards are issued throughout the country by individual kabeles at age 18 to permanent residents of that area who request it and whose family is on that kabele’s records. The card is valid only in the local area. People who do not have a card, or have moved from where the card was issued, are effectively undocumented in the sense that is usually applied to international migrants who lack valid visas. Without it, a person may not have rights to land and water; to a passport; to vote; to register a marriage or a birth; file a legal case or open a bank account. They may not access welfare, employment, education, health and accommodation, and it can even be difficult to purchase a SIM card, or enter public buildings such as courts and airports.36

Lack of an ID card drives sex workers’ vulnerability in specific ways. Those without the card must either suffer the consequences of lack of access to services and resources or make alternative arrangements to access them. Those alternative strategies frequently involve turning to middlemen, quacks, loan sharks and other informal contracts as well as borrowing, sharing or renting ID cards. Some HIV-positive sex workers told us that they share ID cards to obtain the medications and care that are not provided free to HIV patients.

It was beyond the scope of this case study to enumerate the proportion of sex workers who have an ID card but all interviewees described the proportion of sex workers with valid ID cards as ‘very few’ and ‘hardly any’. Several reasons for this were given, including that sex workers are drawn from the poorest communities in the country in which ID registration is lowest and that most sell sex away from their area of origin so any card they had is no longer valid. NGOs also stressed the importance of the ID cards. Both the national director of the Wise Up programme and the programme’s local manager in Bahir Dar said that the organisation supports sex workers to obtain ID cards. A prosecutor confirmed that the government perceives the identity cards as playing an important role in security and crime prevention because it enables the government to locate people. She said that the procedure for obtaining a new ID card when a citizen relocates must be rigorous to prevent people obtaining multiple identities.

The rules and practices around adults obtaining an ID card are inconsistent, expensive and can be difficult to navigate. As internal migrants most sex workers cannot meet the criteria although some said that they, or their friends, had obtained an identity card as a result of tolerance and flexibility on the part of local authority.37 They said some kabeles sometimes allow sex workers to give the address of a bar or an NGO for the purposes of obtaining an identity card. There is clear potential for better policy practices around ID cards to make a significant contribution to reducing sex workers’ poverty and vulnerability to exploitation.

In Shashamene, it was mentioned that in Ethiopia money cannot be transferred by mobile phone as it is in other parts of Africa. The group were keen to know more about how the transfers work but one woman commented, ‘Well, when it comes to Ethiopia we’ll be the last

36 For more information, view the Administrative Law section in the Social Justice Toolkit (forthcoming). 37 The requirements are usually some cumulative combination of: a. three months’ documented residence in a recognised address (not a slum); b. endorsement by the recognised head of that household; c. a testimony from a ‘reputable witness’ that testifies the person has been in that area for a specified period; d. recognised employment (not sex work or unsupported householder); e. certificate of leave from the place of previous or original residence.

24 to benefit from it’. By ‘we’ she meant sex workers without ID cards. Another women said of ID cards, ‘if you don’t exist, you can’t claim anything can you?’ Box 6.1 Having ‘the right papers’: a structural determinant of sex workers’ poverty

The example of access to ID cards in this case study illustrates the need for better documentation of structural factors that cause or compound sex workers’ poverty. Everyone we spoke with in Ethiopia knew that lacking an ID card is a disadvantage. Most knew that sex workers strategies for ‘getting around’ not having a card can expose them to exploitation and some projects already help sex workers obtain ID cards.

Another example, from wealthier countries, is that criminal records and lack of a tax history reduce sex workers’ ability to move into formal employment or obtain the finance necessary to establish homes and businesses. Failure to identify these important determinants means that opportunities for policy reform that could significantly and cost-effectively reduce vulnerability are being missed.

6.3 Poverty alleviation programmes Although we did not thoroughly map EEPs for sex workers in Ethiopia, the information gathered from the literature and in-country informants raises some key issues around economic empowerment policy and programmes.

The EEPs we identified all involved small numbers of participants compared with the total number of sex workers in the area.38 The national HIV prevention programme, Wise Up, provided short training courses (two days) to 100 sex workers through self-help groups formed at its drop-in centres in 2013 with a view to ‘experts’ in mainstream finance institutions providing seeding money for subsequent microfinance for the groups (Wise Up 2013).39 A project operated by a US university established an infrastructure (including foreign staff and purchased sewing machines) to provide 10 sex workers with the support and technical skills necessary to secure alternative employment.40 Slightly higher numbers of beneficiaries are reported by Christian EEPs such as Women at Risk, but they are still fewer than 100 per project.41 There have been some innovative approaches to reaching more sex workers with social and economic empowerment. The Wise Up programme which was operating in 28 towns has provided basic literacy courses that are open to all local sex workers. Another Wise Up project involved 500 sex workers from different cities and towns in talent competitions in which the prizes were intensive life skills and entrepreneurship training along with courses in theatre, music, traditional and modern dance, literature, fine art, and film making.

Despite government policy that recommends poverty alleviation and social protection programmes for sex workers, coverage is seen as patchy and uncoordinated. The women we interviewed were concerned that the programmes operate for short periods of time and lack resources or technical expertise. Although some information exists about the size and type of EEPs, as in the international literature, most reports describe processes but contain no information about outcomes.42 The EEPs we visited understandably kept only the records they need which, in the case of the smaller projects that do not report to foreign donors, are in Amharic and limited to business accounts.

38 For example, 82 Nikat members were eligible to participate in its income generating programme in Addis Ababa. Two idirs and an NGO-based IGA we visited in Addis Ababa reported 112, 46 and 27 such members respectively. 39 No information has been published about the subsequent phases or outcomes of this programme. 40 The Vulnerable Women Empowerment Program – VEWEP; see www.davisprojectsforpeace.org/media/view/401/original/. 41 See www.w-a-r-e.org/. 42 Wise Up reports thorough data in English on the many services and activities it provides throughout the country but it does not include outcomes of EEPs.

The question of whether EEPs should aim to provide alternative or supplementary income is an important but unanswered question. As discussed above, EEPs variously aim to help women to leave sex work; to sell sex more safely; or to recover from having been abused. However, because sex work is a subsistence occupation in Ethiopia and women live in extreme poverty despite selling sex, any distinctions between these goals are blurred by a universal and overriding desire to escape chronic, acute poverty. This raises the problem that EEPs that offer no more than the possibility of matching sex workers’ existing inadequate income level ask women to undergo potentially demoralising selection processes and take risks in order to be poor in a different way. A woman in Addis Ababa who used an IGA in this way explained this dynamic:

To support my family and live with any kind of dignity would cost 100 birr [about 3 pounds] per day. I make between 20 and 70 birr from sex work, but only on some days. I make 25 to 50 [from the IGA]. Sometimes I can make a few birr in another way. What is sure is that every day, with all I do, I always have less than what I need.

On this reasoning, it is not surprising that at least some women in this situation would use income from EEPs to add to their income rather than to exchange one for the other. But the idea that sex work is so abhorrent that any other kind of income generating activity is better can lead to an overestimation of the value of being ‘poor in a different way.’ This is evident in the Vulnerable Ethiopian Women Empowerment Program (VEWEP) that states:

After conducting over 60 interviews, we selected 10 women to participate in the program… We wanted to ensure that project funds would benefit those women most dedicated to rehabilitating themselves and making the initial sacrifices necessary to invest in their future (such as attending class instead of working and generating income). We also wanted to find women who turned to this line of work due to dire or extreme circumstances and could be considered the most destitute… We saw firsthand how valuable VEWEP was as we interviewed the women and saw the look in their eyes change from shame of their past to hope and excitement about how different their lives would be upon their completion of VEWEP. 43

A sex worker, speaking about the selection process said ‘even to get training or something from the centre (NGO drop-in centre) we have to stay here so that they (NGO social workers) can see our (good) behaviour first but the owners don’t allow us to come here’ (Van Blerk 2007: 83).

The NGO and idir-based projects we visited said that even where the stated aim was for women to leave sex work, in reality a ‘blind eye’ was turned to whether or not members continued to sell sex. One convenor of an IGA commented that in the seven years of her programme, which operates a restaurant, returning to sex work had only been problematic when it adversely affected the woman’s contribution to the group. However, others commented that women were sometimes ejected for returning to sex work, especially from faith-based programmes that were not observed for this case study.

Financial viability of EEPs also emerged as a key issue in Ethiopia as it does in international reports on the topic. There is little evidence of EEPs or training programmes having been planned according to calculations about the fiscal viability of the enterprises or even the saleability of the goods or services they produce. Several anecdotes about the failure of business enterprises were recounted. A recurring theme was that of goods being produced for which there was no distribution or marketing plan. This may be due to inadequate resourcing and a lack of technical skills. In one case a woman said she had earned no money from making scrubbing brushes that took her over an hour each because the NGO

43 See www.davisprojectsforpeace.org/media/view/401/original/ (accessed 28 April 2014). No results of the outcomes of the project for its ten beneficiaries have been published.

26 had tried to sell them for five times the price of brushes imported from China. We were also told about computers and hairdressing equipment appearing in projects but no teachers being provided; a restaurant for which the rent exceeded possible income; handicrafts that were more expensive and less attractive than those available commercially; and loans and start-up grants promised but not delivered.

These challenges are not unique to initiatives aimed at sex workers. They arise in literature on EEPs for other populations, too. For example, a STOP AIDS NOW! study in Ethiopia and Uganda documented a number of factors that limit the success of livelihood-strengthening programmes for people with HIV, including lack of evaluation, and struggles to develop effective business plans, sustainable markets and distribution strategies. The authors of the study suggest that projects may not be sustained because they are financed on an activity- specific basis rather than from operational budgets. They also noted that objectives were not clear to staff and beneficiaries and that there was a disconnect between intended objectives and those pursued on the ground. Beneficiaries complained about the difficulties of group- based activities because they offer some a free ride on the efforts of others, and jealousy or resentment on the part of non-beneficiaries was observed. In the projects studied, beneficiaries’ choice of activity was often constrained by the amount, timing or conditions of the support offered and there was a risk that stereotypical activities that focus on common livelihood responses may not be the most rewarding. Concluding that there is much to be gained from assessments and discussion between the organisation, its partners, donors and intended beneficiaries, the study recommends that a ‘community of practice’ be developed to facilitate this (Loevinsohn, Tadele and Atekyereza 2012). Box 6.2 Why economic initiatives for sex workers fail: key findings ● Coerced participation, detention and human rights violations; ● Stigma; ● Lack of sex worker participation; ● Local economic conditions that limit markets and employment; ● Inapplicability of models to informal/chaotic economic settings and mobile populations; ● Lack of funding required to award grants or loans as planned; ● Inadequate training; ● Lack of genuine commitment of programme operators; ● Poor targeting, selection or recruitment methods; ● Start-up grants too small to start a viable business; ● Insufficient demand for products and services; ● Poor marketing and business models; ● Projects are not sustained over time, yet are still required to make measurable change.

7 Economic empowerment of sex workers – a risky but worthwhile business

7.1 Addressing complex interactions of poverty, choice, risk and circumstances Both the international literature and information gathered in Ethiopia point clearly to the incentive poverty provides to girls and women to enter the sex industry and the role it plays in compounding sex workers’ vulnerability to abuse and exploitation within the sex industry. However, a closer look at the role of poverty in women’s entry into sex work reveals complex confounding factors such as reduced social capital and personal capacities associated with family breakdown; economic shocks; sexual abuse; ethnicity; migration (Lekan 2007); food insecurity (Weiser et al. 2007); coercion (Sahini 2008); and other pre-existing social and gender inequalities within the labour force, discrimination and lack of citizenship (UNAIDS 2012; Wittman 2011; Supreme Court of India: Budhadev Karmaskar v State Of West Bengal44). Because it is a matter of fact not opinion that sex work is judged by some women to be safer and better paying than other available options, presumptions that sex work is an occupation of last resort entered as a result of bad decisions or lack of agency must be questioned. Another point worth keeping in mind is that, even in a setting as poor as Ethiopia, women – particularly young women – experience the same desire for excitement, freedom and cultural and economic opportunities that drive people all over the world to travel or try risky work (Doezema 2001). Nor can it be presumed that poverty necessarily means that sex workers make poor choices within the sex industry. On the contrary, in some places it has been observed that poverty provides impetus for women to pursue safe sex practices and remain healthy (Dasgupta 2013). While none of this debunks the proposition that poverty drives women to sell sex, it does disrupt the binary notion that because poverty drives women into sex work poverty alleviation can pull them away from it. Less prejudiced and more nuanced understandings of the varied and complex economic and social dynamics that lead individual women to enter sex work are needed to develop law, policy and programming that address economic issues in ways that benefit the most women possible.

7.2 Pathways, roadblocks and wrong turns on the road to economic empowerment of sex workers The clearest pathway to poverty alleviation is economic growth in a legal and policy environment that enables women the benefit of gaining access to formal, waged work and to benefits and protections. But what policies and programmes can do to best address sex workers’ economic needs in the meantime is less clear. Although there are many cases of individuals and communities in Ethiopia and elsewhere benefiting from EEPs, it is difficult to learn specific lessons or identify the characteristics of successful empowerment initiatives. No conceptual framework has emerged and experts in the field are divided about what poverty alleviation for sex workers should achieve and how to best achieve it. Nor have best practices been identified. Microfinance has been criticised for failing to increase incomes, driving poor households and marginalised people into a debt trap, particularly where interest rates and default penalties are high (Doezema and Overs 2009; Brett 2006; Mayoux 1999). Pressure to repay debts can in itself be disempowering; borrowers’ savings are sometimes taken as collateral, interest rates are often high and women’s already heavy workloads can be increased (Doezema and Overs 2009). Simpler forms of poverty alleviation such as buyers’ clubs and cooperative income generating projects that produce goods or local

44 See http://nlrd.org/womens-rights-initiative/supreme-court-latest-orders-and-judgements/supreme-court-sex-workers- rehabilitation-case-budhadev-karmaskar-vs-state-of-west-bengal (accessed 24 April 2014).

28 services have been documented in various settings but have also been criticised for failing to lead to sustainable markets (the viability of selling handicrafts in particular has been questioned) and for trapping women into poorly paid informal work rather than forming a portal to sustained and healthy employment (Karnani 2007).

Sex workers’ rights advocates have praised efforts such as those of the Usha Cooperative45 and Empower46 to ground economic programmes in human rights and respect for sex work as an occupation rather than salvation which is seen by many sex workers as disempowering, moralistic and often associated with coercive law enforcement or inappropriate evangelism (Sherman et al. 2010).47 A project in Goa, India, developed a model that aimed to provide a more holistic approach to economic and social reintegration of sex workers because, ‘when working towards providing alternative employment you have to take care to think about whether it will provide for an individual’s needs… To tackle this you need a modern rehabilitation programme which unfortunately we have so far failed to develop’ (Bhasin 2013).

There have also been critiques of the neoliberal values implicit in the idea that participation in the market economy can empower sex workers. In the words of a development specialist writing about a sex worker empowerment program in Guatemala:

[I]t is time to revisit what we mean when we discuss female empowerment within a developmental context, and reconfigure it away from a preoccupation with neoliberal markers of success and towards the often complex reality of women’s lives. Development is not about rescuing people and, no matter how much the Nike Foundation would have you believe it, neither is it as simple as ‘giving a girl a cow’. (Bowman 2014)

Doezema and Overs have argued that ‘the key to empowerment that is more than just lip service lies in the direct and meaningful participation of those affected. For sex workers, meaningful empowerment goes beyond personal enrichment to an expressly communal and political effort to change structures of oppression’. On this analysis, sex workers taking the lead – as sex workers and not as repentants divested of their occupational identity – is crucial because it is respectful of women’s agency in decision-making, including the decision to engage in sex work (UNAIDS 2012).

7.3 Lessons from successes and failures Sex worker-led programmes typically aim to provide supplementary as well as alternative income to sex workers. Such an approach places abstinence or reducing numbers of sex partners in a continuum with other outcomes and strategies for improving quality of life rather than privileging it above all others in a hierarchy developed by outsiders. It also allows scope for building on skills gained in sex work rather than rejecting them for their association with immorality or victimhood. A Thai NGO worker explained that in her project this had led to sex workers demanding training for occupations such as casino croupier, tourist guide, massage therapist, taxi driver and cocktail waitress. She contrasted this with the sewing, cooking and hairdressing that are usually offered (Liz Hilton pers. comm. 2013).

If programme failure is defined as women rejecting programmes, programmes collapsing or not resulting in women leaving sex work or achieving other anticipated positive outcomes, it is observably persistent across published literature as well as in news items and reports

45 See http://ushacoop.org/. 46 See www.empowerfoundation.org/index_en.html. See also: Rights Not Rescue at www.opensocietyfoundations.org/reports/rights-not-rescue; DMSC at http://durbar.org/. 47 Although it is not discussed in detail here, it should be noted that there have been controversies about the evangelical nature of some rehabilitation programmes, particularly where they have been operated by Christians in non-Christian countries.

(Zweynert 2011; Jakarta Post 2010; Nigerian Curiosity 2010; IRIN 2009; Campbell 2003). The experiences of failure provide as many lessons as success stories.

One cause of programme failure stands out above all others – the women are coerced into programmes and/or kept against their will. A Nigerian EEP manager commented:

Those who are voluntary easily accept the rehabilitation process… The involuntary ones will want to go back [to sex work] as it will be difficult to rehabilitate them. Those who were enjoying the business will not want to get out no matter what you do for them because they take pleasure in what they were doing. This is why the rehab centres are like prisons to them, as soon they are opportuned, they may want to jump out. (Aborisade and Aderinto 2008: 136)

Indeed, although we saw no evidence of this in Ethiopia, there is a wealth of stories of human rights abuses in rehabilitation centres and sex workers breaking out of them, particularly in Asia where involuntary detention for occupational training and rehabilitation therapy and other violations of both trafficked and non-trafficked persons have been documented (DNA News 2014; Soenthrith and Neubauer 2004). These include forced HIV tests (African Spotlight 2014; Furuhashi 2000), performance of unpaid labour, inadequate sanitation and nutrition, and assaults (Overs 2009). Women can be prohibited from contacting family, friends or outside agencies, particularly if they are waiting to testify in a court case treated as witnesses (Stabroek News 2012; RATS-W Team Empower Foundation 2010). Box 7.1 Economic empowerment – a risky business

Women at Baan Kredtrakarn (Thailand), as in many other shelters, are obliged to work making dolls and handicraft items to be sold in the shelter store that is also behind the shelter walls on the island. They are not paid for their labour when making these products, they do not have the option of setting prices, or choosing where to sell their products, and receive only 70 per cent of sale price if the product sells – with the shelter keeping the rest ‘for the cost of the tutor and materials’. If your products don’t sell you are never compensated for your time or labour, even though the work is not an optional activity. ‘I was dropped off here in Mae Sai (on the Thai Burma border) with a bag of cloth dolls to make and sell. No one wanted to buy them. I went back to my old boss and luckily he gave me my job back in the karaoke bar.’

Source: RATS-W Team Empower Foundation (2010).

A second stream of criticism is that EEPs do not lead to ongoing economic opportunities. For example, World Vision said of Thailand, ‘the training and skills offered to trafficked persons in Thailand are of limited use where there is no opportunity for work in their home countries due to lack of economic development’ (RATS-W Team Empower Foundation 2010). A study in Botswana, Namibia and South Africa concluded that rehabilitation programmes failed to reduce violence or improve conditions; none of the sex workers in the study who had completed rehabilitation programmes had managed to obtain gainful employment from their training, and many complained that they earned much less money (Arnott and Crago 2009). According to Vivienne Mentor-Lalu from the Sex Worker Education and Advocacy Taskforce (SWEAT), at best ‘they [EEPs] offer women an alternative job in another part of the informal economy that is equally if not more unpredictable, and often leads to the women earning much less money’ (IRIN 2009). The study also found that groups who offered both rehabilitation services and HIV prevention and condoms, created significant tension for sex work programme participants. Sex workers who want to win the approval of staff or benefit from skills training will sometimes lie about no longer doing sex work, which means that they can no longer receive condoms or other HIV prevention services.

Similarly, a sex worker in Ethiopia said that she was tired of answering questions about her life for various NGOs or institutes’ studies on sex work because this work failed to create, initiate, or establish initiatives that would enable her to leave sex work (Belai and Getachew 2008). These failures may be due to poor business planning, lack of the skill needed to identify markets, inappropriate targeting and project design, or other fundamental shortcomings. One of these, which should not be overlooked, is that the true motive of the operators of the project may not be the benefit of the women who use the service but the operators’ own profit.

Lack of appreciation of the factors that determine women’s ability to move across social and economic spaces has also driven programme failure. A study of outcomes of women given assistance to set up businesses in Nigeria after repatriation from Europe showed that those classified as sex workers fared no better than those who were deported and given no assistance. The small food stands they set up with the money did not thrive because the women lacked the status or protection needed to make them work. All the women interviewed had been the victims of armed robbery or rape or both (Plambech 2014, forthcoming). In this context it’s not surprising that some of them said it was ‘much safer to sell sex in Rome or Hamburg than to sell food from a food stall in Benin City’ (Bergstrøm 2013). Again, this is an inversion of the familiar discourse that posits sex work as dangerous and other occupations as providing relief from danger.

Unfortunately where programmes fail it is frequently attributed to sex workers’ greed or moral laxity rather than to technical or conceptual shortcoming of the programmes or the quality of the agencies that operate them. Campbell’s work is an exception. She analyses in detail the factors that undermined an EEP in a South African mining town (Campbell 2003). She found that the mainly migrant sex workers had been wrongly assumed to be communities of individuals with common interests whereas they were in fact diverse and there were external influences and conflicting interests among powerful groups. She also notes the lack of economic viability of the alternative income generating activities and the lack of internal cohesion in the aims and management of the project. A project in Mongolia also noted that microcredit was unsuitable for sex workers because the pressure to avoid default can increase risky behaviour (Tsai et al. 2011).

A Nigerian study that examined the coping patterns of victims of sex trafficking at six rehabilitation centres operated by NGOs, government and faith-based organisations identified several barriers to success, including stigma that prevents employers taking on former sex workers. It also observed that the projects it examined were not grounded in a genuine desire to help the women on the part of NGOs but in the financial opportunity that operating an EEP can provide. These opportunities for funding arise where developing countries need to be seen to address sex trafficking to escape sanctions related to the US Trafficking in Persons Policy (Aborisade and Aderinto 2008).

7.4 Learning lessons, gathering evidence and building a community of practice The needs assessments we heard or read about appeared designed to elicit responses that fit with the narrative of shame related to sexual promiscuity and the possibility of redemption implicit in changing occupation. This is grounded in at least two factors. The first is the assumption that commercial sex is the worst kind of work so that anything would be an improvement. The second is sex workers’ responses when they are asked if they want a different job. The answer will almost invariably be positive, especially in settings as poor as Ethiopia. That EEPs so often fail to retain participants who have said they want a different job suggests that this approach oversimplifies sex workers’ experience of poverty and fails to take into account different needs and aspirations among women of different ages,

31 backgrounds, familial and health statuses. An NGO programme officer discussing sex workers’ positive responses when asked if they want a different job said:

‘Yes’ may mean, ‘yes, so long as it’s not backbreaking work for long hours’ or ‘yes so long as it doesn’t involve providing sexual favours’ or ‘yes, but not in a garment factory because that’s where I came from’ or ‘yes because I’m no longer earning enough money from sex work’ or ‘yes, but I am moving to another town quite soon’. (Rosanna Barbaro pers. comm. 2006)

The opportunities to learn about and strengthen the EEPs for sex workers or develop supportive policy are constrained by lack of mapping or analysis of existing EEPs or related policy. This is striking given the accepted link between poverty and sex work and the number of poverty reduction and rehabilitation initiatives operating with high level support, and the funding they receive from organisations including the UN, USAID and key international NGOs. Such agencies usually only support a policy or programming when there is clear evidence of cost-effectiveness, sustainability and the potential to be expanded to cover a large-enough group of people to make a measurable difference. Normally research would be undertaken to inform planning programmes and donors, and key agencies would publish guidance including a conceptual framework, examples of good practice and tools for training, implementation and evaluation. But none of this has happened around EEPs for sex workers. Where there have been reviews they have focused on HIV prevention and they are not recent. Of the many projects and initiatives located in our literature review only four contained outcome data and that was for more than one year in only two of them (Pronyk, Barnett and Watts 2008; Blankenship et al. 2006).

Sex workers and members of the gay, lesbian and transgender community march for poverty reduction in Cambodia. Source: © Women’s Network for Unity. Information about results of individual projects is, in the majority of cases, anecdotal rather than based on data or clear indicators. As in Ethiopia, much of the reporting by EEPs is framed in terms of narratives of moral or spiritual salvation, frequently for promotional or fundraising purposes.48 There is insufficient information to identify strengths and weaknesses of specific methods of economic empowerment activities or components of programmes. For example, some experts have observed that bringing women together regularly over months and years to repay loans and deposit and share savings creates opportunities to address HIV and other issues in a group setting (USAID 2010; Blankenship et al. 2006). However,

48 Many narratives about individual women leaving sex work as a result of an economic empowerment programme are published in conjunction with requests for donations or funding. See, for example, E-War Ethiopia www.w-a-r-e.org/history.html.

32 others have identified collectivisation as problematic in the context of sex work and recommend or implement models that are less reliant on mutual dependence or shared responsibility (Sherman et al. 2010; Campbell 2003).

A further concern is that it is not always clear in the reports and articles which women are admitted to programmes and how outcomes vary between, for example, migrants and non- migrants, women from different sectors of the sex industry or women of different ages. In many cases it is not clear if programmes are provided to adult sex workers, trafficking victims, sexually exploited minors or young women considered to be at risk of becoming sex workers. Frequently these terms are used interchangeably.

This vacuum reflects a history of ideological controversy around sex work that has created a breech into which it is dangerous to step. Those who see sex work as inherently degrading or abusive support rehabilitation as a strategy for liberating victims from slavery or violence. This is explicit in the case of some feminist organisations that define sex work as violence against women and faith-based organisations that define it as sin. It is also the position of the US government whose PEPFAR legislation and policy specifically state that sex work is inherently degrading; require that all grantee organisations have an anti-prostitution policy; and prioritise funding organisations that focus on promoting abstinence.49 Less explicit is the UN which has taken a more secular route to reach a similar conclusion. Consistent with the Convention on Ending Discrimination against Women (CEDAW),50 UN agencies recognised poverty alleviation and rehabilitation of sex workers as fulfilling human rights objectives. According to Thoraya Ahmed Obaid, the executive director of the United Nations Population Fund (UNFPA):

The rights to education, health and income are basic human rights of which many women are deprived. Poverty, trafficking and violence drive women into the sex trade. Therefore, by providing support to women to have other work options in their lives, we shall be promoting their basic human rights. (Doezema and Overs 2009: 7)

Others, including sex worker activists, have disagreed with this ‘abolitionist’ formulation of human rights. Sex worker activists saw it as prioritising the right not to be a sex worker over the rights sex workers must claim in order to work in the sex industry safely and live with dignity in their private lives (Ahmed 2011). This came to the fore in 2009 when UNFPA, in its role as the UN agency leading on sex work, issued guidance on HIV prevention for sex workers that recommended that member states and donors invest HIV funds in girls’ education to prevent entry into sex work; in the rehabilitation of sex workers; and condoms for those who refused rehabilitation (Global Working Group on HIV and Sex Work Policy 2010). The guidance was retracted and replaced with a version that invoked the principles of harm reduction and to a lesser extent labour rights (Seshu, Bandhopadhyay and Overs 2009). Importantly for this discussion, the revised UN guidance expanded its view of economic empowerment from an exclusive focus on women leaving sex work to an approach that enhances all life choices and options, including those within the sex industry.

49 For an account of the issues around this policy see Anti-Prostitution Pledge Materials OSI, www.opensocietyfoundations.org/publications/anti-prostitution-pledge-materials. 50 CEDAW Article 6 requires countries to aim to eliminate all forms of trafficking of women and exploitation of prostitution of women.

Sex worker activists have adopted slogans and images that specifically reject rehabilitation, ‘Don’t talk to me about sewing machines, talk to me about sex workers’ rights’ and ‘Save Us From Saviors’. Source: © Vamp. Since these debates were played out, rights advocates have continued to criticise rehabilitation that is associated with moralistic and/or coercive attempts to ‘save’ individuals, to abolish sex work or to conflate it with human trafficking (Agustín 2014; Day 2014; Garcia- Vargas 2014; Magar 2012; RATS-W Team Empower Foundation 2010).

Lack of evaluation and documentation of EEPs targeted at sex workers has not attracted criticism or concern, possibly because it is not known how much is spent on them or because their value is assumed.

Taken together, these gaps and ideological disconnects obstruct efforts to assess the value of economic empowerment programming generally or to improve it by understanding which aspects of such programmes work well, for whom, or why. Thus it is not possible to draw any meaningful conclusions about where money and energy are well spent or wasted, or if harm or unintended consequences are caused. This is problematic because the fact remains that, although no amount of economic empowerment or social protection will eliminate commercial sex, gender equality, poverty alleviation and public health efforts certainly have the potential to be significantly enhanced by effective EEPs for sex workers. If effective programming could be developed and bought to scale, as well as directly benefiting participants with enhanced livelihoods, the supply of labour and the powerlessness of workers in the sex industry would be reduced. This would in turn benefit non-participating sex workers by strengthening their position to negotiate price, work conditions and safe sex.51

Economic empowerment is a critical component of initiatives to reduce vulnerability and enable sex workers to gain greater control over their lives. Policies and programmes that can alleviate poverty among sex workers are those that reduce harm, increase options, respect individual sex workers’ decisions, are well planned and executed and are compatible with local economic and social conditions.

51 It must be noted that, for the total number of women selling sex to be reduced, initiatives that accelerate the process of existing sex workers leaving the sex industry would have to be complemented by measures that slow the flow of women and girls into the sex industry. Such measures include enforcement of laws against child sexual exploitation and social protection and education for girls.

Women from an income generating collective serve lunch at a police training session. Photographer: © Timret Lehiwot, 2011. Policies must be informed by reliable data and should aim to support as many sex workers as possible to achieve equal citizenship and economic integration rather than offer charity or salvation for a few. Programmes must be voluntary and grounded in informed consent and other important ethical principles and not be forced on women or given as an alternative to punishments such as jail or deportation. Care should be taken that such programmes do not increase stigma and are not withheld from women who are judged to be unsuitable or undeserving of inclusion. Like other programmes, the impact of EEPs on poverty, public health and child welfare should be evaluated using strong indicators and research methods. This is currently not occurring, possibly because EEPs and the policy that supports them exist on the periphery of public health and development programmes and are not given due attention by donors or within national economic planning processes.

This study therefore worked to address this dearth of policy guidance by providing empirical evidence and, as outlined below, a set of corresponding policy recommendations at an international and national level to ensure that development programmes reach all population constituents, including sex workers.

8 Recommendations

8.1 International

8.1.1 Map and evaluate existing economic empowerment policies and programmes for sex workers There is an urgent need for information to support both policy and programming, and to enable NGOs, donors and programme planners to allocate resources most effectively. This should include mapping existing economic empowerment policies and programmes for sex workers nationally and regionally, and operations research that identifies their impact.

8.1.2 Document evidence and develop a conceptual framework The recommendations about economic empowerment programmes and policies adopted by UNAIDS in 2011 should be built into an explicit and authoritative conceptual framework to support production of measurable results and protection of human rights (see section 1 above).

8.1.3 Delineate sex work and trafficking The conflation of trafficking and sex work is a significant obstruction to scholarship and knowledge management in this field. For policy, law and programmes that affect women who sell sex to be effective, clear definitions are required of adult sex workers; women forced to sell sex; sex workers who have been trafficked; and migrant sex workers.

8.1.4 Identify structural determinants of poverty and develop policy to minimise them Policies are needed that reduce sex workers’ economic exclusion, enable sex workers to benefit from population-level poverty alleviation efforts, and enable them to assert legal rights in respect of both administrative and criminal law. Like Ethiopia, most developing countries have policies on poverty and most recognise the importance of gender equality, and the value of targeting women in social protection programmes and of ensuring women’s economic inclusion with measures to reduce gender-based discrimination or restore property rights. The extent to which sex workers benefit from those policies should be measured and the exact nature of the barriers documented.

8.1.5 Improve needs assessment tools Experience shows that sex workers drift away from microfinance or income generating projects if they realise that their personal economic goals will not be met or it is costing too much to continue. One of the keys to averting repeated failure discussed above is to develop strategies to properly understand women’s personal economic and social goals and their attitude to sex and sexuality before the programme starts. Better situation assessment and technical guidance are needed.

8.1.6 Ensure programme viability and scale It is counterproductive for sex workers to be promised ‘a new life’ in activities that are not viable or to spend time making goods that do not produce profit. Training programmes must lead to employment or saleable skills.

Programmes that reach only a small proportion of the population of interest are considered inadequate, no matter how good their results are among that small population. This should

36 apply to sex worker EEPs. Careful examination of how many sex workers can benefit from a given strategy and the potential for the programme to be scaled up should be conducted at the planning stage. The aims and coverage of such programmes should be a matter of national policy wherever possible.52

8.1.7 Improve planning and evaluation tools Future research should explore associations between outcomes of economic empowerment programmes for particular participants. The following are examples of variables that should be considered:

● Mobility. Sex work is a highly mobile occupation in both space and time. In most settings women move in and out of working in the sex industry relatively often and many work infrequently or seasonally. The same applies to geographical mobility because sex workers typically move between towns, cities and countries for various reasons including avoiding stigma, legal persecution, to access new clients or to overcome food insecurity or economic and social shocks and conflict. How do programme outcomes of stable, full-time, self-identified sex workers compare with mobile or infrequent sex workers? What kinds of interventions meet the respective needs of stable and migrant sex workers? ● Age. Younger and older women frequently have different obligations, attitudes, skills, assets and earning capacity, both in sex work and other occupations. How do programme outcomes of older women compare to those of younger women? Could better targeting lead to more sustainable or effective programming? ● Entry mode. Women and girls come to different types of programmes in different ways. Rescued trafficking victims undergo economic programmes as aftercare. Others are arrested or detained in raids by police and NGOs and compelled to undergo rehabilitation. Others come to gain access to sexual health services or accommodation. Others arrive entirely voluntarily or even compete for a place in a programme. How do these different ways of coming into EEPs affect outcomes? ● Health and family status. Adult female sex workers have different numbers of children and other dependents and some have disabilities or HIV. Are there any particular benefits or costs to particular categories of women? Should programmes or recruitment be tailored differently for women in different circumstances and, if so, how? ● Organisation. What kind of organisational structure is best suited to delivering what type of programme in which setting? How do indigenous schemes (such as the idir of Ethiopia) compare with self-help schemes (such as the Usha Cooperative of Sonagachi Kolkata), traditional NGOs (such as KWVOC Kenya), government or religious programmes? What are the strengths and weaknesses of the various organisational models?

8.1.8 Clarify HIV prevention and care goals The issue of the proportion of women included in economic empowerment programmes for sex workers is particularly important if HIV prevention and care is the goal. To be justified, economic empowerment policy and programming for sex workers must lead to a measurable and significant increase in safe commercial sexual transactions, to fewer overall commercial sexual transactions or to less people involved in those transactions, or a combination of these.

52 As discussed above, in the wake of a decision of the Supreme Court, India is gradually becoming a model for integrating the rehabilitation of sex workers into national policy.

8.1.9 Observe and prevent harm Like all development interventions, EEPs can produce unexpected negative impacts. These include direct human rights abuses, increased stigma, depoliticised sex worker communities, and time and energy wasted on activities that do not lead to real benefits. Another possibility is that programmes create tensions between different sectors such as local and displaced people, and between sex workers selected for programmes and those who are rejected. Local traders may also be hostile to the possibility of saturating the market with a certain product or service that has been subsidised (especially if that is by a foreign donor). All possible risks should be considered and planned for before initiating programmes.

8.2 Ethiopia

8.2.1 Law Although the criminal law against adult sex work is not enforced, it does exacerbate poverty by depriving sex workers of the civil rights and access to services they need. To remove structural determinants of poverty the law should be removed to make way for sex workers to claim rights under labour and other administrative legal provisions and to benefit from anti- discrimination and other human rights law. Although this may not seem realistic at first glance, with the right international support, Ethiopia could reform the laws against consenting adult sex work as part of a programme of clamping down on trafficking and against child sexual abuse.

8.2.2 Policy

● The inclusion of sex workers in Ethiopia’s Social Protection Policy should be recognised and applauded. Extra resources should be made available to the FDRE to distribute to local government to implement and monitor programmes and policy. ● A mechanism should be developed and put in place urgently to ensure that all adult women born in Ethiopia who sell sex are able to obtain an ID card regardless of their location, background or other status.

8.2.3 Programming Ethiopia is well placed to significantly advance EEPs for sex workers. NGOs already working with sex workers should be evaluated and provided with tools and guidance. Foreign aid donors and churches should not be relied upon to implement EEPs as ‘add-ons’ to HIV programmes or as pastoral care. Rather sex workers’ access to the sustainable opportunities offered by the traditional idir system should be expanded. The following are recommended steps for strengthening programmes.

Mapping As a first step toward strengthening the approaches that produce optimal outcomes and reducing the possibility of wasted resources and damage associated with poor programmes, the FDRE, with UN and civil society support, should map and assess social protection and economic empowerment initiatives for sex workers throughout the country. To do this it will be necessary to develop or adapt research tools.

Guidance Increased attention to economic policy and programmes should be geared toward broader consultation and development of guidance and tools for planning, implementing and evaluating EEPs.

Scaling up The potential to extend Ethiopia’s traditional economic empowerment mechanisms for poor and marginalised groups to include large number of sex workers should be explored. Similarly, the potential for strengthening and systematising links between HIV prevention and care projects and poverty alleviation initiatives should be explored. If this is successful, sex worker EEPs would benefit from better business plans and tools.

Participation The most sustained, popular and effective EEPs in Ethiopia and abroad are those in which sex workers play a role in management rather than participating solely as beneficiaries of schemes established and managed by others. Accordingly donors, UN agencies and government should invest in building sex workers’ capacity to design, implement and monitor EEPs.

References

Aborisade, A. and Aderinto, A. (2008) ‘Adjustment Patterns and Obstacles against Social Rehabilitation of Sex Workers in Nigeria’, African Sociological Review 12.2: 128–143

African Spotlight (2014) Malawi Sex Workers Seek Damages after Police Forced them to Take HIV Tests, www.africanspotlight.com/2014/02/25/malawi-sex-workers-seek-damages- police-forced-take-hiv-tests/ (accessed 24 April 2014)

Agustín, L. (2014) The Naked Anthropologist, www.lauraagustin.com/ (accessed 24 April 2014)

Agustín, L. (2009) Exiting in the Opposite Direction: from Maids to Sex Workers in Ethiopia, http://sexgenderbody.com/content/exiting-opposite-direction-maids-sex-workers-ethiopia (accessed 24 April 2014)

Ahmed, A. (2011) ‘Feminism, Power and Sex Work in the Context of HIV/Aids: Consequences for Women’s Health’, Harvard Journal of Law & Gender 34: 226-228, www.law.harvard.edu/students/orgs/jlg/vol341/225-258.pdf (accessed 24 April 2014)

AIDSTAR-One (2014) Microfinance, HIV, and Women's Empowerment, www.aidstar- one.com/focus_areas/gender/resources/technical_briefs/microfinance_hiv_and_womens_em powerment (accessed 24 June 2014)

Alsop, R. and Heinsohn, N. (2005) ‘Measuring Empowerment in Practice: Structuring Analysis and Framing Indicators’, Policy Research Working Paper 3510, Washington DC: World Bank

Arnott, J. and Crago, A-L. (2009) Rights Not Rescue: A Report on Female, Male, and Trans Sex Workers’ Human Rights in Botswana, Namibia, and South Africa, New York: Open Society Institute

Assefa, M. (2004) ‘Female-headed Households and Poverty in Urban Ethiopia’, in D. Kassahun and M. Assefa (eds) (2005), Issues in Urban Poverty, Addis Ababa: Forum for Social Studies

Bateman, M. (2011) Microfinance as a Development and Poverty Reduction Policy: is it Everything it’s Cracked Up to Be?, ODI Background Note, London: Overseas Development Institute

Bekerie, A. (2003) Iquib and Idir: Socio-Economic Traditions of the Ethiopians, Tadius Online, www.tadias.com/v1n6/OP_2_2003-1.html (accessed 12 June 2014)

Bekker, L.; Johnson, L.; Overs, C.; Cowan, F.; Besada, D.; Hillier, S. and Cates, W. (2014, forthcoming) ‘Combination HIV Prevention for Female SWs: What is the Evidence?’, The Lancet

Belai, H. and Getachew, H. (2008) ‘Vulnerable Women Empowerment Program’, Columbia University, www.davisprojectsforpeace.org/media/view/401/original/ (accessed 12 June 2014)

Bergstrøm, I.I. (2013) ‘Life in Nigeria after Selling Sex in Europe’, Information Center for Gender Research in Norway, http://eng.kilden.forskningsradet.no/c52778/nyhet/vis.html?tid=85201 (accessed 12 June 2014)

Bhasin, T. (2013) ‘Goa Looks to Provide Holistic Rehabilitation to Sex Workers’, The Sunday Guardian, www.sunday-guardian.com/young-restless/goa-looks-to-provide-holistic- rehabilitation-to-sex-workers (accessed 24 April 2014)

Binagwaho, A.; Agbonyitor, M.; Mwananawe, A.; Mugwaneza, P.; Irwin, A. and Karema, C. (2010) ‘Developing Human Rights-based Strategies to Improve Health among Female Sex Workers in Rwanda’, Health and Human Rights 12.2: 89–100

Blankenship, K.M.; Friedman, S.; Dworkin, S. and Mantell, J. (2006) ‘Structural Interventions: Concepts Challenges and Opportunities for Research’, Journal of Urban Health 83.1: 59–72

Bowman, H. (2014) Guatemala Women Sex-workers Live in a Dangerous ‘Twilight’ World, http://womennewsnetwork.net/2014/03/17/guatemala-women-sex-workers-world/2014 (accessed 12 June 2014)

Brett, J.A. (2006) ‘“We Sacrifice and Eat Less”: the Structural Complexities of Microfinance Participation’, Human Organisation 65.1: 8–19

Campbell, C. (2003) Letting them Die: Why HIV/AIDS Prevention Programmes Fail, Oxford: James Currey

Chowdhury, A.R. (2013) ‘The Savings Habits of Prostitutes in Kolkata Red Light Areas: A Comprehensive Study’, International Proceedings of Economics Development and Research 64: 6–11

CIA (2012) The World Factbook – Ethiopia, www.cia.gov/library/publications/the-world- factbook/geos/et.html (accessed 12 February 2014)

Dasgupta, S. (2013) ‘Poverty as a Contextual Factor Affecting Sexual Health Behavior among Female Sex Workers in India’, Qualitative Health Research 23.6: 825–833

Day, S. (2014) Criminalising the Sex Industry, Goldsmiths University of London, www.gold.ac.uk/academics/sophiedaysexindustry.php (accessed 12 June 2014)

Devereux, S. and Sabates-Wheeler, R. (2007) ‘Editorial Introduction: Debating Social Protection’, IDS Bulletin 38.3: 1–7

DKT/IRIN News (2010) Ethiopia: Maids, Condoms and Kerosene, www.irinnews.org/report/86409/ethiopia-maids-condoms-and- (accessed 3 May 2014)

DNA News (2014) Six Women Escape from Deonar Shelter Home, www.dnaindia.com/mumbai/report-six-women-escape-from-deonar-shelter-home-1965616 (accessed 24 April 2014)

Doezema, J. (2001) ‘Ouch! Western Feminists’ “Wounded Attachment” to the “Third World Prostitute”’, Feminist Review 67 (Spring): 16–38

Doezema, J. and Overs, C. (2009) Good Money after Bad Women: Empowering Sex Workers through Micro-credit?, Paulo Longo Research Initiative, www.plri.org/resource/good- money-after-bad-women-empowering-sex-workers-through-micro-credit (accessed 24 April 2014)

Empire of Ethiopia (1960) The Civil Code Proclamation of 1960, www1.umn.edu/humanrts/research/Civil%20Code%20%28English%29.pdf (accessed 12 June 2014)

Family Health International (2002) Mapping Commercial Sex Work in Addis Ababa (summary), www.globalhivmeinfo.org/DigitalLibrary/Digital%20Library/ActivitySummarySizeEstimation6- 16-04.pdf (accessed 24 April 2014)

Federal Democratic Republic of Ethiopia (2011) Ethiopia Joint Flagship Programme on Gender Equality and Women’s Empowerment, www.gov.uk/government/publications/ethiopia-joint-flagship-programme-on-gender-equality- and-womens-empowerment

Federal Democratic Republic of Ethiopia (2004a) The Criminal Code of the Federal Democratic Republic Of Ethiopia, Proclamation No. 414/2004

Federal Democratic Republic of Ethiopia (2004b) Vagrancy Proclamation of the Federal Democratic Republic Of Ethiopia, Proclamation No. 384/2004

Federal Democratic Republic of Ethiopia (2003) Labour Proclamation No.377/2003, www.ilo.org/dyn/travail/docs/327/Proclamation%20No%20377_2003%20- %20Labour%20Proclamation.pdf (accessed 24 April 2014)

Federal Democratic Republic of Ethiopia (1995) Constitution of the Federal Democratic Republic of Ethiopia, www.africa.upenn.edu/Hornet/Ethiopian_Constitution.html (accessed 24 April 2014)

Federal Democratic Republic of Ethiopia Ministry of Finance (MoFED) and Economic Development (2010) Growth and Transformation Plan 2010/11–2014/15, Addis Ababa: MoFED

Federal Democratic Republic of Ethiopia Ministry of Health (2009) Report on Situation Analysis of the National Prevention of Mother-to-Child Transmission of HIV/AIDS Programme Response in the Broader Reproductive Health/Mother-and-Newborn-Child Health Context in Ethiopia, Addis Ababa: Ministry of Health

Federal Democratic Republic of Ethiopia Ministry of Health (2008) Compact between the Government of the Federal Democratic Republic of Ethiopia and the Development Partners on Scaling Up For Reaching the Health MDGs through the Health Sector Development Program in the Framework of the International Health Partnership (IHP), Addis Ababa: Ministry of Health

Federal Democratic Republic of Ethiopia Ministry of Health (2006) National Reproductive Health Strategy 2006-2015, Addis Ababa: Ministry of Health

Federal Democratic Republic of Ethiopia Ministry of Health (2004) Aids in Ethiopia: 5th Report, Addis Ababa: Disease Prevention and Control Department

Federal Democratic Republic of Ethiopia Ministry of Labour and Social Affairs (2012) National Social Protection Policy of Ethiopia, Addis Ababa: Ministry of Labour and Social Affairs

FHAPCO (2010) Report on Progress towards Implementation of the UN Declaration of Commitment on HIV/AIDS, Addis Ababa: Federal HIV/AIDS Prevention and Control Office

Furuhashi, Y. (2000) Bombay High Court Intervenes to ‘Rescue’ Child Sex Workers, Socio Legal Information Centre, http://archives.econ.utah.edu/archives/m- fem/2000m09/msg00224.html (accessed 24 April 2014)

Garcia-Vargas, A. (2014) Sex Workers: We’re Not a Rescue Project, Not Trafficking Victims, Bustle, www.bustle.com/#/articles/13651-sex-workers-were-not-a-rescue-project-not- trafficking-victims (accessed 24 April 2014)

Getu, M. (2006) ‘Human Trafficking and Development: The Role of Microfinance’, Transformation: An International Journal of Holistic Mission Studies 23: 142–156

Global Working Group on HIV and Sex Work Policy (2010) Draft Reworking of the UNAIDS Guidance Note on HIV and Sex Work, http://sexworkpolicy.wordpress.com/ (accessed 24 April 2014)

Greenall, M. (2007) Review of the Evidence Base for an ‘Evidenced-based’ Policy on HIV Programming with Sex Workers, Paulo Longo Research Initiative, www.plri.org/resource/sex- work-and-economics-%E2%80%93-rapid-annotated-bibliography (accessed 24 April 2014)

ILO (2014) Social Protection: Building Social Protection Floors and Comprehensive Social Security Systems, www.ilo.org/gimi/gess/ShowTheme.do?tid=11 (accessed 28 April 2014)

International Center for Not-for-Profit Law (2014) NGO Law Monitor: Ethiopia, www.icnl.org/research/monitor/ethiopia.html (accessed 24 April 2014)

International Federation for Human Rights (2009) Ethiopia, Freedom of Expression in Jeopardy, www.fidh.org/Ethiopia-Freedom-of-association-in (accessed 24 April 2014)

IRIN (2009) Trying to Give Sex Workers Safer Alternatives, www.irinnews.org/report/87087/africa-trying-to-give-sex-workers-safer-alternatives (accessed 24 April 2014)

Jakarta Post (2010) ‘Street Workers Return to the Streets after Rehabilitation’, www.thejakartapost.com/news/2010/02/12/sex-workers-return-streets-after- rehabilitation.html (accessed 24 April 2004)

Jenkins, C. (2006) Violence and Exposure to HIV among Sex Workers in Phnom Penh, Cambodia, Washington DC: United States Agency for International Development, www.hivpolicy.org/Library/HPP001702.pdf (accessed 24 April 2014)

Kabeer, N. (1998) Money Can’t Buy me Love? Re-evaluating Gender, Credit and Empowerment in Rural Bangladesh, IDS Discussion Paper 363, Brighton: IDS

Karnani, A. (2007) ‘Microfinance Misses Its Mark’, Stanford Social Innovation Review 2007, www.ssireview.org/articles/entry/microfinance_misses_its_mark/ (accessed 24 April 2014)

Kayitenkore, K.; Bekan, B.; Rufagari, J.; Marion-Landais, S.; Karita, E.; Allen, S. and RZHRG (2006) ‘The Impact of ART on HIV Transmission among HIV Serodiscordant Couples’, poster discussion: AIDS 2006 – XVI International AIDS Conference, abstract no. MOKC101, Toronto, Canada

Kennedy, C.; Fonner, V.; O’Reilly, K. and Sweat, M. (2014) ‘A Systematic Review of Income Generation Interventions, Including Microfinance and Vocational Skills Training, for HIV Prevention’, AIDS Care 26.6: 659–73

Lei Ravelo, J. (2013) A year on, NGOs still struggle in Ethiopia without Zenawi, Devex, www.devex.com/news/a-year-on-ngos-still-struggle-in-ethiopia-without-zenawi-81695 (accessed 24 April 2014)

Lekan, O. (2007) ‘Poverty, Sexual Practices and Vulnerability of Female Sex Workers to HIV/AIDS Pandemic in Lagos Metropolis, Nigeria’, Gender and Behaviour 5.2: 1260–1278

Linzee Gordon, F. (2000) Lonely Planet Guide to Ethiopia, Eritrea and Djibouti, Melbourne: Lonely Planet

Loevinsohn, M.; Tadele, G. and Atekyereza, P. (2012) Livelihood and Economic Strengthening in Communities Confronting HIV and AIDS: An Exploratory Study in Uganda and Ethiopia, STOP AIDS NOW!, www.ids.ac.uk/publication/livelihood-and-economic- strengthening-in-communities-confronting-hiv-and-aids-an-exploratory-study-in-uganda-and- ethiopia (accessed 24 April 2014)

Magar, V. (2012) ‘Rescue and Rehabilitation: A Critical Analysis of Sex Workers’ Anti- trafficking Response in India’, Signs 37.3: 619–644

Mayoux, L. (1999) ‘Questioning Virtuous Spirals: Micro-Finance and Women’s Empowerment in Africa’, Journal of International Development 11.7: 957–984

Meehan, F. (2004) Female Headed Households in Tigray, Ethiopia, DCG Report 35, Ås, Norway: The Drylands Coordination Group

Miller, C.H. (2010) ‘Sewing for Change – a Partnership to Improve the Lives of Women Micro-entrepreneurs Living with HIV in Shashamene, Ethiopia’, report submitted for MA, Southern New Hampshire University, School of Community Economic Development

Mooney, A. (2013) ‘Work-related Violence and Inconsistent Condom Use with Non-paying Partners among Female Sex Workers in Adama City, Ethiopia’, BMC Public Health 13: 771

Muletta, T. (2012) ‘Rights-based Approach to HIV Prevention and Economic Empowerment among Sex Workers in Addis Ababa’, Ethiopia International AIDS Conference 2012, Addis Ababa, 22–27 July, www.iasociety.org/Default.aspx?pageId=12&abstractId=200736295 (accessed 12 June 2014)

Nganwa, P. (2013) Resources for Poverty Eradication: a Background Paper for Development Initiatives, Nairobi: Development Initiatives, http://devinit.org/wp- content/uploads/2013/08/Ethiopia-Resources-for-poverty-eradication.pdf (accessed 12 June 2014)

Nigerian Curiosity (2010) Sending Prostitutes to Rehab in Nigeria, www.nigeriancuriosity.com/2010/08/sending-prostitutes-to-rehab-in-nigeria.html (accessed 24 April 2014)

Odek, W.O.; Busza, J.; Morris, C.N.; Cleland, J.; Ngugi, E.N. and Ferguson, A.G. (2009) ‘Effects of Micro-enterprise Services on HIV Risk Behaviour among Female Sex Workers in Kenya’s Urban Slums’, AIDS and Behavior 13.3: 449-461

Overs, C. (2013) From Sex Work to Entertainment and Trafficking: Implications of a Paradigm Shift for Sexuality, Law and Activism in Cambodia, IDS Evidence Report 23, Brighton: IDS, www.ids.ac.uk/publication/from-sex-work-to-entertainment-and-trafficking- implications-of-a-paradigm-shift-for-sexuality-law-and-activism-in- cambodia#sthash.o4ox5Wty.dpuf

Overs, C. (2009) Caught between the Tiger and the Crocodile: The Campaign to Suppress Human Trafficking and Sexual Exploitation in Cambodia, Paulo Longo Research Initiative, www.plri.org/sites/plri.org/files/caught-between-the-tiger-and-the-crocodile.pdf (accessed 24 April 2014)

Parker, J.; Singh, I. and Hattel, K. (2000) The Role of Microfinance in the Fight against HIV/AIDS, Maryland: The Joint United Nations Program on HIV/AIDS (UNAIDS)

Plambech, S. (2014, forthcoming) ‘Between “Victims” and “Criminals” – Nigerian Migrant Sex Workers and the Politics of Rescue’, in E. Bernstein (ed), Social Politics: International Studies in Gender, State and Society – Special Issue on Sexual Economies and New Techniques of Governance, Oxford: Oxford University Press

Porteous, T. (2010) Development without Freedom: How Aid Underwrites Repression in Ethiopia, www.opendemocracy.net/tom-porteous/ethiopia-aid-politics-trap (accessed 24 April 2014)

Project Parivartan (2008) Bibliography on Community Mobilization and Empowerment, https://docs.google.com/a/student.american.edu/viewer?a=v&pid=sites&srcid=c3R1ZGVudC 5hbWVyaWNhbi5lZHV8cHJvamVjdC1wYXJpdmFydGFufGd4OjdmZjI1OWIzYzc2ZDM3Y2E (accessed 13 June 2014)

Pronyk, K.; Barnett, T. and Watts, C. (2008) ‘Exploring the Role of Economic Empowerment in HIV Prevention’, AIDS 22 (Supplement 4): S57–S71

Pronyk, P.; Kim, J.; Hargreaves, J.; Makhubele, M.B.; Morison, L.A.; Watts, C. and Porter J.D.H. (2005) ‘Microfinance and HIV Prevention – Emerging Lessons from Rural South Africa’, Small Enterprise Development 16.3: 26–38

RATS-W Team Empower Foundation (2010) Hit and Run, www.empowerfoundation.org/sexy_file/Hit%20and%20Run%20%20RATSW%20Eng%20onli ne.pdf (accessed 13 June 2014)

Reniers, G. (2009) ‘Steep Declines in Population-level AIDS Mortality Following the Introduction of Antiretroviral Therapy in Addis Ababa, Ethiopia’, AIDS 23.4: 511–18

Sahini, R. (2008) Prostitution and Beyond: An Analysis of Sex Workers in India, London: Sage Publications

Seshu, M.; Bandhopadhyay, N. and Overs, C. (2009) ‘How the Development Industry Imagines Sex Work’, Development 52: 13–17

Sherman, S.G.; Srikrishnan, A.K.; Rivett K.A.; Liu S-H.; Solomon, S. and Celentano, D.D. (2010) ‘Acceptability of a Microenterprise Intervention among Female Sex Workers in Chennai, India’, AIDS and Behavior 14.3: 649–657

Sobeyko, J.; Leszczyszyn-Pynka, M.; Duklas, T.; Parczewski, M.; Bejnarowicz, P.; Burris, S.C.; Lazzarini, Z.; Case, P. and Chintalova-Dallas, R. (2006) Bridging the Gaps between Needs and Services in the Health and Criminal Justice Systems: Szczecin RPAR Final Report and Recommendations, Social Science Research Network, http://dx.doi.org/10.2139/ssrn.1276335 (accessed 24 April 2014)

Social Watch (2001) Ethiopia – National Report, www.socialwatch.org/node/10741 (accessed 24 April 2014)

Soenthrith, S. and Neubauer, I. (2004) ‘Women Taken from Afesip Protest to US’, Cambodia Daily, 13 December, www.cambodiadaily.com/archives/women-taken-from-afesip-protest-to- us-44614/ (accessed 24 April 2014)

Stabroek News (2012) Flight of Rescued Girls could Hamper Investigation – De Souza, www.stabroeknews.com/2012/news/stories/05/01/flight-of-rescued-girls-could-hamper- investigation-de-souza/ (accessed 24 April 2014)

Teferra, S. (2012) Agency within Ethiopian Sex Work: Withstanding Violence, www.opendemocracy.net/5050/sehin-teferra/agency-within-ethiopian-sex-work-withstanding- violence (accessed 24 April 2014)

Temple University (2006) Rapid Policy Assessment and Response, www.temple.edu/lawschool/phrhcs/rpar/index.html (accessed 24 April 2014)

The Economist (2007) ‘A Brittle Western Ally in the Horn of Africa’, 1 November, www.economist.com/node/10062658 (accessed 13 June 2014)

Tirfe, M. (1999) The Paradox of Africa’s Poverty: The Role of Indigenous Knowledge, Traditional Practices and Local Institutions, Lawrenceville, NJ: The Red Sea Press

Tsai, L.C.; Witte, S.S. and Aira, T. (2011) ‘Piloting a Savings-led Microfinance Intervention with Women Engaging in Sex Work in Mongolia: Further Innovation for HIV Risk Reduction’, The Open Women’s Health Journal 5: 26–32, http://benthamscience.com/open/towhj/articles/V005/26TOWHJ.pdf (accessed 13 June 2014)

UNAIDS (2012) Guidance Note on Sex Work and HIV and Annexes 2012, www.nswp.org/resource/unaids-guidance-note-hiv-and-sex-work-and-annexes-2012 (accessed 1 May 2014)

UN Women (2013) New Horizons: Ethiopian Women Join Efforts to Escape Poverty, www.unwomen.org/en/news/stories/2013/4/new-horizons-ethiopian-women-join-efforts-to- escape-poverty#sthash.WU1MiaX2.CW41TVnq.dpuf (accessed 24 April 2014)

United States Department of State (2010) Trafficking in Persons Report 2010 – Ethiopia, www.unhcr.org/refworld/docid/4c1883f528.html (accessed 24 April 2014)

USAID (2010) Microfinance, HIV, and Women’s Empowerment Technical Brief, Arlington, VA: USAID/AIDSTAR-One Project, www.aidstar- one.com/sites/default/files/Microfinance4_1.pdf (accessed 13 June 2014)

Van Blerk, L. (2007) ‘AIDS, Mobility and Commercial Sex in Ethiopia: Implications for Policy’, AIDS Care 19.1: 79–86

Weiser, S.; Leiter, K; Bangsberg, D.; Butler, L.; Percy-de Korte, F.; Hlanze, Z.; Phaladze, N.; Iacopino, V. and Heisler, M. (2007) ‘Food Insufficiency is Associated with High-risk Sexual Behavior among Women in Botswana and Swazliland’, PLoS Medicine 4.10: 1589–97

WHO (2005) HIV/AIDS Sex Work Toolkit, Geneva: World Health Organization, www.who.int/hiv/topics/vct/sw_toolkit/assessment/en/index1.html (accessed 13 June 2014)

Wise Up (2013) Wise Up 1st and 2nd Quarter Reports 2013, www.wiseuprogram.org/index.php?option=com_content&view=frontpage&Itemid=1 (accessed 13 June 2014)

Wittman, C. (2011) ‘From Rice Fields to Red Light Districts: An Economic Examination of Factors Motivating Employment in Thailand’s Sex Industry’, Masters Thesis, Kansas State University, Department of Agricultural Economics, College of Agriculture, www.plri.org/resource/rice-fields-red-light-districts-economic-examination-factors-motivating- employment-thailand (accessed 13 June 2014)

WomenWatch (1997-2008) Ethiopian National Action Plan on Women, www.un.org/womenwatch/confer/beijing/national/ethiopia.htm (accessed 13 June 2014)

World Bank (2010) ‘Sex Worker-run Restaurant Fights Stigma and Discrimination in Mysore’, The World Bank in India 8.4: 1–4, Lodhi Estate, New Delhi: Public Information Centre, www- wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2010/04/09/000333038_2 0100409013900/Rendered/PDF/538610NEWS0WB010Box345632B01PUBLIC1.pdf (accessed 13 June 2014)

World Bank (2001) Engendering Development: Through Gender Equality in Rights, Resources, and Voices, Policy Research Report, New York: Oxford University Press, Inc./The International Bank for Reconstruction and Development/The World Bank

Yntiso Deko, G. (2012) Civil Society and Income Generation Activities in Ethiopia – Final Report, Development Assistance Group ETHIOPIA, www.dagethiopia.org/index.php?option=com_content&view=article&id=177:civil-society-and- income-generation-activities-report&catid=84:tecs&Itemid=131 (accessed 1 May 2014)

Zweynert, A. (2011) Rehabilitation Cuts No Ice with India’s Sex Workers, Thomson Reuters Foundation, www.trust.org/item/20110328162600-zimwj/?source=shtw (accessed 24 April 2014)

IDS_Master Logo

Brighton BN1 9RE

T +44 (0)1273 606261 F +44 (0)1273 621202 E [email protected] www.ids.ac.uk